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. 2024 Mar;28(1):9-19.
doi: 10.4235/agmr.23.0121. Epub 2023 Nov 15.

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

Nere Larrea Aguirre  1 , Susana García Gutiérrez  1   2 , Oscar Miro  3 , Sira Aguiló  3 , Javier Jacob  4 , Aitor Alquézar-Arbé  5 , Guillermo Burillo  6 , Cesáreo Fernandez  7 , Pere Llorens  8 , Cesar Roza Alonso  9 , Ivana Tavasci Lopez  10 , Mónica Cañete  11 , Pedro Ruiz Asensio  12 , Beatriz Paderne Díaz  13 , Teresa Pablos Pizarro  14 , Rigoberto Jesús Del Rio Navarro  15 , Núria Perelló Viola  16 , Lourdes Hernández-Castells  17 , Alejandro Cortés Soler  18 , Elena Sánchez Fernández-Linares  19 , Jesús Ángel Sánchez Serrano  20 , Patxi Ezponda  21 , Andrea Martínez Lorenzo  22 , Juan Vicente Ortega Liarte  23 , Susana Sánchez Ramón  24 , Asumpta Ruiz Aranda  25 , Francisco Javier Martín-Sánchez  7 , Juan González Del Castillo  7
Affiliations

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

Nere Larrea Aguirre et al. Ann Geriatr Med Res. 2024 Mar.

Abstract

Background: 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.

Methods: We included all patients ≥65 years attending 52 EDs in Spain over 7 days. 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.

Results: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years-mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) 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 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80-0.82) for 30-day mortality.

Conclusion: 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.

Keywords: Emergencies; Frail elderly; Geriatrics; Triage.

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Conflict of interest statement

CONFLICT OF INTEREST

The researchers claim no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flowchart for the inclusion of patients in the EDEN cohort.
Fig. 2.
Fig. 2.
Forest plot results for the four outcomes: (A) 30-day mortality, (B) 30-day readmission, (C) 30-day re-presentation, and (D) 30-day poor outcome.
Fig. 3.
Fig. 3.
Kaplan-Meier curves for the variables studied: (A) 30-day mortality, (B) 30-day readmission, (C) 30-day re-presentation, and (D) 30-day poor outcome.
See this image and copyright information in PMC

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