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Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons.
Justine M Nagurney1, William Fleischman2, Ling Han3
1Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Annals of Emergency Medicine
|January 11, 2017
Summary
Emergency department visits without hospitalization increase functional decline in older adults. This highlights a vulnerable period post-ED visit, impacting disability and mortality risks.
Area of Science:
- Gerontology
- Public Health
- Emergency Medicine
Background:
- Disability and functional decline in older adults are linked to higher mortality, institutionalization, and healthcare costs.
- Older individuals visiting the emergency department (ED) without subsequent hospitalization represent a significant population group requiring further study regarding their health outcomes.
Purpose of the Study:
- To investigate the association between emergency department (ED) visits not resulting in hospitalization and subsequent functional decline in community-living older persons.
- To compare the functional trajectory of older adults experiencing an ED visit without hospitalization against a control group and those hospitalized after an ED visit.
Main Methods:
- A longitudinal cohort study involving 754 community-living older persons followed for up to 14 years.
- Matched analysis comparing 813 ED visits without hospitalization (ED-only) to 813 control observations, with a 6-month follow-up for disability.
- Secondary outcomes included nursing home admissions and mortality, analyzed using generalized linear models and survival analysis.
Main Results:
- The ED-only group exhibited significantly higher disability scores compared to the control group (risk ratio 1.14; 95% CI 1.09 to 1.19) over 6 months.
- Older adults hospitalized after an ED visit showed even greater disability increases (risk ratio 1.17; 95% CI 1.12 to 1.22) than the ED-only group.
- The ED-only group experienced higher rates of nursing home admission (hazard ratio 3.11) and mortality (hazard ratio 1.93) compared to controls.
Conclusions:
- Emergency department visits for older adults, even without hospitalization, are associated with a meaningful decline in functional status over the subsequent six months.
- The post-ED visit period is a critical window of vulnerability for community-dwelling older individuals, necessitating targeted interventions.
- These findings underscore the importance of post-ED care strategies to mitigate functional decline and adverse outcomes in the elderly population.
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