Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study

Abstract

Objectives: The objective was to describe the prevalence of geriatric conditions among older medical patients in the emergency department (ED) and the association with admission, mortality, reattendance and loss of independency.

Design: Population-based prospective cohort study.

Setting: ED of a large university hospital.

Participants: All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).

Primary and secondary outcome measures: Based on information from healthcare registers, we defined geriatric conditions as disability, recently increased disability, polypharmacy and comorbidity. Outcomes were admission, length of admission, 30 days postdischarge mortality, 30 days hospital reattendance and home care dependency 0-360 days following ED contact.

Results: Totally, 3775 patients (55% women) were included, age 78 (71-85) years (median (IQR)). No patients were lost to follow-up. The prevalence of 0-4 geriatric conditions was 14.9%, 27.3%, 25.2%, 22.3% and 10.3%, respectively. The number of conditions was significantly associated with hospital admission, length of admission, 30 days postdischarge mortality and 30 days hospital reattendance. Among patients with no geriatric conditions, 70% lived independent all 360 days after discharge, whereas all patients with ≥3 conditions had some dependency or were dead within 360 days following discharge.

Conclusion: Among older medical patients in the ED, 50% had two or more geriatric conditions which were associated with poor health outcomes. This highlights the need for studies of the effect of geriatric awareness and competences in the ED.

Keywords: emergency department; geriatric emergency medicine; geriatric patients; mortality; older patients.

Figure 1

Flow chart of patients included in the study period.

Figure 2

The proportion of patients discharged alive who died were dependent on home care or were independent of home care in relation to the number of geriatric conditions (disability, recently increased disability, polypharmacy and comorbidity) in the (A) 30 days period after discharge (B) 360 days period after discharge.