Elderly patients in the Emergency Department: Which patients should be selected for a different approach?

While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strat...

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Detalhes bibliográficos
Autores: Aguirre, Nere Larrea, García Gutiérrez, Susana, Miro, Oscar, Aguiló, Sira, Jacob, Javier, Alquézar-Arbé, Aitor, Burillo, Guillermo, Fernandez, Cesáreo, Llorens, Pere, Roza-Alonso, Cesar, Tavasci Lopez, Ivana, Cañete, Mónica, Ruiz Asensio, Pedro, Paderne Díaz, Beatriz, Pablos Pizarro, Teresa, Del Rio Navarro, Rigoberto Jesús, Perelló Viola, Núria, Hernández-Castells, Lourdes, Cortés Soler, Alejandro, Sánchez Fernández-Linares, Elena, Sánchez Serrano, Jesús Ángel, Ezponda, Patxi, Martínez Lorenzo, Andrea, Ortega Liarte, Juan Vicente, Sánchez Ramón, Susana, Ruiz Aranda, Asumpta, Martín-Sánchez, Francisco Javier, González Del Castillo, Juan
Formato: artículo
Fecha de publicación:2023
País:España
Recursos:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/20181
Acesso em linha:https://hdl.handle.net/20.500.13003/20181
Access Level:acceso abierto
Palavra-chave:Aged
Aged, 80 and over
Comorbidity
Emergency Service, Hospital* / statistics & numerical data
Female
Geriatric Assessment / methods
Humans
Male
Patient Readmission* / statistics & numerical data
Spain / epidemiology
Anciano
Comorbilidad
Femenino
Humanos
Masculino
Descrição
Resumo:While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. We included all patients ≥65 years attending 52 EDs in Spain over 7 d. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years (mean age 78.4 [SD 8.1] years, 12,626 (54.1%) women). During follow-up, 5,776 (24.75) patients had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69) were readmitted 30 d after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Cormorbidity Index ≥3, and functional impairment had a C-index of 0.81 (0.80-0.82) for 30-day mortality. Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.

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