Ann Geriatr Med Res.  2024 Mar;28(1):9-19. 10.4235/agmr.23.0121.

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

• Aguirre NL
• Gutiérrez SG
• Miro O
• Aguiló S
• Jacob J
• Alquézar-Arbé A
• Burillo G
• Fernandez C
• Llorens P
• Alonso CR
• Lopez IT
• Cañete M
• Asensio PR
• Díaz BP
• Pizarro TP
• Navarro RJdR
• Viola NP
• Hernández-Castells L
• Soler AC
• Sánchez Fernández-Linares E
• Serrano J
• Ezponda P
• Lorenzo AM
• Liarte JVO
• Ramón SS
• Aranda AR
• Martín-Sánchez FJ
• del Castillo JG
• on behalf of the members of the SIESTA Network

• KMID: 2553845
• DOI: http://doi.org/10.4235/agmr.23.0121

Abstract

Background
While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes.
Methods
We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes.
Results
During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years—mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80–0.82) for 30-day mortality.
Conclusion
Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.

Keyword

Emergencies; Geriatrics; Frail elderly; Triage