Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

Abstract

Purpose: The study purpose was to assess the effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories associated with emergency department visit only, hospitalization, and no event.

Methods: A total of 410 community-dwelling adults aged ≥75 years who were living in the community, were able to communicate by telephone, could schedule an in-home interview, and could answer questions independently were followed from June 2010 to August 2014. In-home baseline and monthly telephone follow-up interviews collected data on LSA scores, emergency department use, and hospitalizations. Life-space is measured using a validated patient-reported tool reflecting community mobility and quality of life. Trajectories of LSA before and after an emergency department visit or hospitalization were compared with no event occurrence.

Results: Mean age of participants was 81.7 years (standard deviation, 4.8); 57% were female, and 35% were African American. During 3 years of follow-up, 83 persons (20%) had an emergency department visit without subsequent hospitalization and 164 persons (40%) were hospitalized. Although baseline LSA scores were similar, in the month after an emergency department visit, adjusted LSA scores decreased by 6.1 points (P = .01) in comparison with hospitalized participants who experienced an average decrease of 18.0 points (P < .0001). Neither those with an emergency department visit only nor those with hospitalization recovered to their prior level of community mobility. Moreover, those with an emergency department visit showed no significant improvement in LSA scores up to 1 year later.

Conclusions: Older adults who experienced an emergency department visit or hospitalization had an associated decrease in community mobility without significant recovery.

Keywords: Aged; Emergency department; Hospitalization; Life-space; Mobility limitation.

Figure 1

Trajectory of unadjusted life-space decrease and recovery for the emergency department visit only, hospitalization, and no event groups Life-space mobility trajectories of participants who had an ED visit only, or were hospitalized are shown in red (dashed) and green (dotted) respectively. The solid blue line shows the trajectory of those without an event. The calendar time for an ED visit or hospitalization was centered at the median time to a first event (58.9 weeks).