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Multicenter Study
. 2020 Sep 21;20(1):355.
doi: 10.1186/s12877-020-01742-1.

Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

Anne-Laure Feral-Pierssens  1   2   3 , Gustave Toury  4 , Fatima Sehimi  5 , Nicolas Peschanski  6 , Saïd Laribi  7   8 , Amélie Carpentier  9 , Magali Kraif  10 , Clément Carbonnier  11   12 , François-Xavier Duchateau  13 , Yonathan Freund  14   15   16 , Philippe Juvin  4   14   17 ; EPIGER IRU-SFMU study group
Collaborators, Affiliations
Multicenter Study

Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

Anne-Laure Feral-Pierssens et al. BMC Geriatr. .

Abstract

Background: For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources' use and patients' outcome.

Methods: A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for "having difficulties coping at home". The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints.

Results: One thousand one hundred sixty-eight patients were included, median age 86(83-89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68-2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65-1.30]). Assisted patients had a lower risk of being admitted for "having difficulties coping at home" (OR = 0.59;95%CI [0.38-0.92]).

Conclusion: Professional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications.

Trial registration: Clinicaltrial.gov - NCT02900391 , 09/14/2016, retrospectively registered.

Keywords: Elderly; Emergency care; Healthcare access; Home services; Loss of autonomy.

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Conflict of interest statement

SL, NP have relevant financial activities outside the submitted work. SL reports personal fees from Aspen, Astra-Zeneca, Bristol-Myers Squibb, Novartis and Roche; NP reports personal fees from Vygon, AstraZeneca, Bayer and non-financial support from Vygon; and the remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of included patients and existing home services
See this image and copyright information in PMC

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