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Functional Decline Prior to Emergency Department Presentation in Older Adults: A Prospective Observational Study
Pei-Ying Lin1, Tse-Yao Wang1, Ying-Ju Chen1
1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Journal of the American Medical Directors Association
|December 1, 2025
Summary
Functional decline before emergency visits is common in older adults. Malnutrition, frailty, and peptic ulcer disease are key risk factors, leading to higher hospital admissions and longer stays.
Area of Science:
- Geriatric Medicine
- Emergency Medicine
- Public Health
Background:
- Functional decline in older adults is a significant concern.
- Identifying predictors of decline before emergency department (ED) presentation is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for functional decline occurring before emergency department visits.
- To examine the association of pre-ED functional decline with patient outcomes.
Main Methods:
- A prospective observational study was conducted with 979 patients aged 65+ admitted to an ED observation unit.
- Comprehensive geriatric assessments were performed within 24 hours of arrival.
- Logistic regression identified independent predictors of functional decline, defined as a decrease in activities of daily living score.
Main Results:
- 42.8% of participants experienced pre-ED functional decline.
- Independent risk factors included malnutrition (aOR 2.83), frailty (aOR 2.17), peptic ulcer disease (aOR 1.70), and age (aOR 1.02).
- Patients with functional decline had higher admission rates (69.0% vs 55.4%) and longer median lengths of stay (9 vs 5 days).
Conclusions:
- Pre-ED functional decline is linked to identifiable clinical factors and worse hospital outcomes.
- Integrating functional assessments into ED evaluations can facilitate early detection and intervention for at-risk older adults.
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