Short- and long-term characteristics and outcomes in patients aged 65 or older living in nursing homes. EDEN-40 study

Abstract

Objective: To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.

Methods: Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.

Results: A total of 23,629 patients were analyzed, of which 1569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11,330 (95% CI 8967-14,314); ambulation with assistance, OR 5687 (95% CI 4759-6796); cognitive impairment, OR 2802 (95% CI 2448-3208); and age over 85 years, OR 2191 (95% CI 1821-2636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1472 (95% CI 1236-1753) and 1421 (95% CI 1282-1576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.

Conclusions: Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.

Keywords: Asistencia a ancianos; Assistance; Atención geriatrica; Elderly; Fragilidad en ancianos; Frail; Geriatric health service; Old age.