Disability and morbidity among older patients in the emergency department

a Danish population-based cohort study

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Resumé

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.

OriginalsprogEngelsk
Artikelnummere023803
TidsskriftBMJ Open
Vol/bind8
Udgave nummer12
Antal sider11
ISSN2044-6055
DOI
StatusUdgivet - 14. dec. 2018

Fingeraftryk

Hospital Emergency Service
Geriatrics
Cohort Studies
Population
Home Care Services
Mental Competency
Comorbidity
Outcome Assessment (Health Care)
Prospective Studies
Delivery of Health Care
Health

Citer dette

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title = "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",
author = "Anette Tanderup and Lassen, {Annmarie Touborg} and Jens-Ulrik Rosholm and Jesper Ryg",
note = "{\circledC} Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2018",
month = "12",
day = "14",
doi = "10.1136/bmjopen-2018-023803",
language = "English",
volume = "8",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Group",
number = "12",

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TY - JOUR

T1 - Disability and morbidity among older patients in the emergency department

T2 - a Danish population-based cohort study

AU - Tanderup, Anette

AU - Lassen, Annmarie Touborg

AU - Rosholm, Jens-Ulrik

AU - Ryg, Jesper

N1 - © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2018/12/14

Y1 - 2018/12/14

N2 - 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.

AB - 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.

KW - Emergency department

KW - Geriatric emergency medicine

KW - Geriatric patients

KW - Mortality

KW - Older patients

U2 - 10.1136/bmjopen-2018-023803

DO - 10.1136/bmjopen-2018-023803

M3 - Journal article

VL - 8

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 12

M1 - e023803

ER -