Functional Decline Prior to Emergency Department Presentation in Older Adults: A Prospective Observational Study

Identify risk factors for pre-emergency department functional decline and its associations with presentations and outcomes.

Prospective observational study.

Tertiary medical center in Taiwan. Patients aged 65 years or older admitted to the emergency department observation unit from March 2021 to December 2022 (n = 979; mean age, 80.3 years).

Within 24 hours of arrival, a structured comprehensive geriatric assessment was performed. Functional decline was defined as a decrease in the activities of daily living score from 2 weeks before the time of emergency department presentation. Demographic, clinical, and functional variables were collected through interviews and medical records. Logistic regression was used to identify independent predictors of pre-emergency department functional decline.

There were 42.8% of participants who experienced functional decline. Independent correlates were malnutrition [adjusted odds ratio (aOR), 2.83], frailty (aOR, 2.17), peptic ulcer disease (aOR, 1.70), and age (aOR, 1.02). Affected patients had higher admission rates (69.0% vs 55.4%) and longer median lengths of stay (9 vs 5 days; both P < .001).

Pre-emergency department functional decline is independently associated with identifiable clinical risk factors and linked to increased hospital admission rates and longer length of stay. Incorporating functional assessments into emergency department evaluations may enable earlier identification and intervention for vulnerable older adults.