1
|
Characteristics of outpatient emergency department visits of nursing home residents: an analysis of discharge letters. Aging Clin Exp Res 2021; 33:3343-3351. [PMID: 33939126 PMCID: PMC8668845 DOI: 10.1007/s40520-021-01863-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 10/30/2022]
Abstract
BACKGROUND Unplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. However, there is little research on what diagnostic and therapeutic measures are performed during visits. AIMS We analyzed underlying diagnoses, characteristics and performed medical procedures of unplanned outpatient ED visits by NHR. METHODS We conducted a multi-center study of 14 nursing homes (NHs) in northwestern Germany in 03/2018-07/2019. Hospital transfers were documented by nursing staff using a standardized questionnaire for 12 months. In addition, discharge letters were used to collect information about the respective transfer, its reasons and the extend of the medical services performed in the ED. RESULTS A total of 161 unplanned ED visits were included (mean age: 84.2 years; 68.3% females). The main transfer reasons were trauma (59.0%), urinary catheter and nutritional probe problems (overall 10.6%; male NHR 25.5%) and altered mental state (9.9%). 32.9% where discharged without imaging or blood test prior. 67.4% of injured NHR (n = 95) required no or only basic wound care. Catheter-related problems (n = 17) were mainly treated by changing an existing suprapubic catheter (35.3%) and by flushing the pre-existing catheter (29.4%). DISCUSSION Our data suggest that the diagnostic and therapeutic interventions performed in ED, often do not exceed general practitioner (GP) care and many ED visits seem to be unnecessary. CONCLUSION Better coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits.
Collapse
|
2
|
Feter N, Leite JS, Umpierre D, Caputo EL, Rombaldi AJ. Multimorbidity and leisure-time physical activity over the life course: a population-based birth cohort study. BMC Public Health 2021; 21:700. [PMID: 33836716 PMCID: PMC8033277 DOI: 10.1186/s12889-021-10719-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/28/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We aimed to test which life course model best described the association between leisure-time physical activity (LTPA) and multimorbidity at age 55. We analyzed data from birth to age 55 using the database from the 1958 National Child Development Survey. METHODS Multimorbidity was considered as the presence of more than one chronic condition. LTPA was measured through questionnaires from 1965 (age 7) to 2013 (age 55), which were applied in eight different occasions. We compared the fit of a series of nested adjusted logistic regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. Data were reported as odds ratio (OR) and 95% confidence interval (CI). RESULTS From an eligible sample of 15,613 cohort members, 9137 were interviewed in the latest sweep (58.5%). Men were more physically active than women at ages 11, 16, and 23 (p < 0.001). LTPA every day in the week was more frequent in women than men in ages 33, 42, and 50 (p < 0.001). The prevalence of multimorbidity at age 55 was 33.0% (n = 2778). The sensitive analysis revealed that LTPA during adolescence (OR: 0.83; 95% CI: 0.70, 0.98) and mid adult life (age 50 and 55; OR: 0.82; 95%CI: 0.69, 0.98) have a stronger effect on the risk for multimorbidity at age 55 considering all other life stages in the model. Also, adolescence showed a critical independent effect on the risk for multimorbidity (OR: 0.82; 95%CI: 0.70, 0.97). No difference was found between those models. CONCLUSIONS These data support the notion of a protective physical activity "legacy" at early ages of childhood against multimorbidity at older ages. We highlight the need for LTPA promotion through intervention tailored especially on schooling and older ages in order to reduce the burden of multimorbidity.
Collapse
Affiliation(s)
- Natan Feter
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil.
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil.
- Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, 4067, Australia.
| | - Jayne S Leite
- Postgraduate Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel Umpierre
- Postgraduate Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Health Technology Assessment Institute, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo L Caputo
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
| | - Airton J Rombaldi
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
| |
Collapse
|
3
|
Rolland Y, Tavassoli N, de Souto Barreto P, Perrin A, Laffon de Mazières C, Rapp T, Hermabessière S, Tournay E, Vellas B, Andrieu S. Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers: The IDEM Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200049. [PMID: 32101308 PMCID: PMC7137681 DOI: 10.1001/jamanetworkopen.2020.0049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular. OBJECTIVE To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016. INTERVENTION Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study. MAIN OUTCOMES AND MEASURES The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months. RESULTS A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24). CONCLUSIONS AND RELEVANCE This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01569997.
Collapse
Affiliation(s)
- Yves Rolland
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Amélie Perrin
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Clarisse Laffon de Mazières
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Thomas Rapp
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Sophie Hermabessière
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Elodie Tournay
- Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Sandrine Andrieu
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
- Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Service d'Epidémiologie, Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| |
Collapse
|
4
|
Drotningsvik A, Oterhals Å, Flesland O, Nygård O, Gudbrandsen OA. Fish protein supplementation in older nursing home residents: a randomised, double-blind, pilot study. Pilot Feasibility Stud 2019; 5:35. [PMID: 30858985 PMCID: PMC6390537 DOI: 10.1186/s40814-019-0421-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/18/2019] [Indexed: 12/25/2022] Open
Abstract
Background Age-related loss of muscle mass and function is common in older adults, and studies investigating if dietary proteins may protect and possibly build lean body mass are needed. We assessed the feasibility of conducting a nutritional intervention study in older nursing home residents to investigate the effects of fish protein supplementation on markers of glucose metabolism and inflammation. Methods This was a double-blind randomised controlled pilot study. Twenty-four nursing home residents, without major cognitive impairment, received a daily oral nutritional supplement containing 5.2 g of fish protein or placebo for 6 weeks. Anthropometric measurements were conducted at baseline. Participants were screened for nutritional risk using the Mini Nutritional Assessment and activities of daily living using the Barthel index and dietary intake was registered. Hand grip strength was measured and fasting blood samples collected at baseline and endpoint. Results Compliance was high and dropout was low, but participant recruitment was challenging. Serum concentrations of monocyte chemoattractant protein-1 decreased, and C-reactive protein increased in the intervention group compared to control, with no changes in markers of glucose metabolism between groups. Conclusion Conducting a nutritional intervention using fish protein supplementation in older nursing home residents is feasible but should be conducted as a multi-centre study to account for the low recruitment rate observed in the present study. A full-scale study is needed to gain more knowledge on the potential effects of fish proteins on markers of glucose metabolism and inflammation in relation to the age-related loss of muscle mass and function. Trial registration ClinicalTrials.gov NCT03529344 18.05.2018 (retrospectively registered)
Collapse
Affiliation(s)
- Aslaug Drotningsvik
- 1Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, PO Box 7804, N-5021 Bergen, Norway.,2TripleNine Vedde AS, 6030 Langevåg, Norway
| | - Åge Oterhals
- 3Nofima, P.O. Box 1425, Oasen, 5828 Bergen, Norway
| | | | - Ottar Nygård
- 4Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.,5Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Oddrun A Gudbrandsen
- 1Dietary Protein Research Group, Department of Clinical Medicine, University of Bergen, PO Box 7804, N-5021 Bergen, Norway
| |
Collapse
|
5
|
Laffon de Mazières C, Romain M, Hermabessière S, Abellan G, Gerard S, Castex A, Krams T, Vellas B, Rolland Y. An Innovative Day Hospital Dedicated to Nursing Home Resident: A Descriptive Study of 1306 Residents Referred by their Physicians. J Nutr Health Aging 2018; 22:1138-1143. [PMID: 30379316 PMCID: PMC6302543 DOI: 10.1007/s12603-018-1106-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The transfer rate of residents from nursing homes (NH) to emergency rooms is high. These transfers are often inappropriate but also potentially avoidable. Recent studies have shown that in terms of methods for training NH teams, proposals for improvement of the healthcare sector must be organized. Given this observation, Gérontopôle de Toulouse (France) opened in October 2015, a responsive day hospital dedicated to NH residents (DH NH). This day hospital is characterized by its vocation, exclusively dedicated to NH residents and its ability to provide patient care within a short period of time. OBJECTIVES The purpose of this day hospital is twofold: (1) decrease the rate of inappropriate transfers for NH residents by offering general practitioners and NH teams quick access to expert advice, blood tests and radiological examinations during hospitalizations and care adapted to the characteristics of NH residents; (2) potentially reduce avoidable transfers to emergency rooms and hospitalizations by taking action to prevent acute decompensation in residents, but also for the education and training of NH healthcare teams. This manuscript aims to describe the arrangements put in place and the characteristics of the residents collected after two years of activity. DESIGN Retrospective descriptive study. SETTING Gérontopôle of Toulouse, France. PARTICIPANTS 1306 residents have been consulted at the DH NH. MEASUREMENTS Referring physicians (treating physicians, coordinating physician or emergency room physicians) send a standardized hospitalization request form to the day hospital by fax or email indicating the reason for the request, specialist opinion(s) desired and additional required examination(s). A gerontological assessment was conducted and anamnesis data was collected for each resident, on the very day of their coming to the DH NH. RESULTS In 2 years, 1306 residents from 120 NHs were sent to the DH NH. The mean age was 86.23 ± 7.05 years and the majority of patients were women (n=941, 72.22%), dependent (median ADL at 2.75, [1.25-4.5]) and malnourished (821, 63.25%). In the 3 months prior to their visit to the day hospital, 668 (57.14%) residents had been hospitalized, and one-quarter (n=336, 25.72%) had been transferred to emergency rooms. The main reasons for hospitalization included assessment of cognitive disorders (n=336, 17.52%), assistance in managing behavioral disorders (n=297, 15.48%) and bedsores and slow wound healing (n=223, 11.63%). CONCLUSION Our experience over a 2-year period suggests that the DH NH could be a practical response to the problem of inappropriate and avoidable transfers of NH residents to emergency rooms. This innovation could easily be utilized in other hospitals.
Collapse
Affiliation(s)
- C Laffon de Mazières
- Clarisse Laffon de Mazières, Department of Geriatric Medicine, Gérontopôle, Toulouse University Hospital, Cité de la santé - 20, rue du Pont Saint-Pierre - TSA 60033 - 31059 Toulouse cedex 9, France. E-mail address : . Tel: +33 (0)5 61 77 70 46
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Atramont A, Bourdel-Marchasson I, Bonnet-Zamponi D, Tangre I, Fagot-Campagna A, Tuppin P. Impact of nursing home admission on health care use and disease status elderly dependent people one year before and one year after skilled nursing home admission based on 2012-2013 SNIIRAM data. BMC Health Serv Res 2017; 17:667. [PMID: 28923106 PMCID: PMC5604505 DOI: 10.1186/s12913-017-2620-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to compare disease status and health care use 1 year before and 1 year after skilled nursing home (SNH) admission. Methods People over the age of 65 years admitted to SNH during the first quarter of 2013, covered by the national health insurance general scheme (69% of the population of this age), and still alive 1 year after admission were identified (n = 14,487, mean age: 86 years, women: 76%). Their reimbursed health care was extracted from the Système National d’Information Interrégimes de l’Assurance Maladie (SNIIRAM) [National Health Insurance Information System]. Results One year after nursing home admission, the most prevalent diseases were cardiovascular/neurovascular diseases and neurodegenerative diseases (affecting 45% and 40% of people before admission vs 51% and 53% after admission, respectively). Physical therapy use increased (43% vs 64% of people had at least one physical therapy session during the year, with an average of 47 vs 84 sessions/person during the year), while specialist consultations decreased (29% of people consulted an ophthalmologist at least once during the year before admission vs 25% after admission; 27% vs 21% consulted a cardiologist). Hospitalization rates were lower during the year following institutionalization (75% vs 40% of people were hospitalized at least once during the year), together with a lower emergency admission rate and a higher day admission rate. Conclusions Analysis of the new French reimbursement database specific to SNH shows that nursing home admission is associated with a reduction of some forms of outpatient care and hospitalizations. Electronic supplementary material The online version of this article (10.1186/s12913-017-2620-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A Atramont
- Caisse Nationale d'Assurance Maladie fund (CNAM-TS), Direction de la Stratégie des Études et des Statistiques, 26-50, avenue du Professeur André Lemierre, F-75986, Paris Cedex 20, France
| | - I Bourdel-Marchasson
- Clinical gerontology department, Centre Henri Choussat, Xavier Arnozan Hospital, 33604, Pessac cedex, France
| | - D Bonnet-Zamponi
- Centre for pharmacoepidemiology (APHP), Paris, France.,OMEDIT: Observatoire des MEdicaments Dispositifs médicaux et Innovations Thérapeutiques d'Ile de France, Paris, France
| | - I Tangre
- Korian Bonisiaca nursing home, 93140, Bondy, France
| | - A Fagot-Campagna
- Caisse Nationale d'Assurance Maladie fund (CNAM-TS), Direction de la Stratégie des Études et des Statistiques, 26-50, avenue du Professeur André Lemierre, F-75986, Paris Cedex 20, France
| | - P Tuppin
- Caisse Nationale d'Assurance Maladie fund (CNAM-TS), Direction de la Stratégie des Études et des Statistiques, 26-50, avenue du Professeur André Lemierre, F-75986, Paris Cedex 20, France.
| |
Collapse
|
7
|
Abstract
OBJECTIVES Nursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences. DESIGN A systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed. SETTING Studies conducted in nursing homes were included. PARTICIPANTS Nursing home residents. PRIMARY AND SECONDARY OUTCOMES Outcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex. RESULTS We identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80-85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses. DISCUSSION Male NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.
Collapse
Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
8
|
Launay CP, de Decker L, Kabeshova A, Annweiler C, Beauchet O. Risk of Unplanned Emergency Department Readmission after an Acute-Care Hospital Discharge among Geriatric Inpatients: Results from the Geriatric EDEN Cohort Study. J Nutr Health Aging 2016; 20:210-7. [PMID: 26812519 DOI: 10.1007/s12603-015-0624-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aims 1) to examine whether items of the brief geriatric assessment (BGA) or their combinations predicted the risk of unplanned emergency department readmission after an acute care hospital discharge among geriatric inpatients, and 2) to determine whether BGA could be used as a prognostic tool for unplanned emergency department readmission. METHODS A total of 312 older patients (mean age, 84.6 ± 5.4 years; 64.1% female) hospitalized in acute care wards after an emergency department visit were recruited in this observational prospective cohort study and separated into 2 groups based on the occurrence or not of an unplanned emergency department readmission during a 12-month follow-up period after their hospital discharge. A 6-item BGA was performed at emergency department admission before the discharge to acute care wards. Information on incident unplanned emergency department readmission was prospectively collected by phone call and by consulting the hospital registry. Several combinations of items of BGA identifying three levels of risk of unplanned emergency department readmission (i.e., low risk, intermediate risk and high risk) were examined. RESULTS The unplanned emergency department readmission was more frequently associated with a temporal disorientation (P=0.004). Area under receiver operating characteristic curves of unplanned emergency department readmission based on BGA items and their combinations ranged from 0.53 to 0.61. The best predictor of unplanned emergency department readmission was the temporal disorientation (hazard ratio>1.65, P<0.035), which defined the high-risk group. Inpatients classified in high-risk group of unplanned emergency department readmission were more frequently readmitted to emergency department than those in intermediate- and low-risk groups (P log Rank <0.004). Prognostic values for unplanned emergency department readmission of items and their combinations were poor with sensitivity below 67%, specificity ranging from 36.4 to 53.7, and positive likelihood ratio below 1.4. CONCLUSIONS The items of BGA and their combinations were significant risk factors for unplanned emergency department readmission, but their prognostic value was poor.
Collapse
Affiliation(s)
- C P Launay
- Olivier Beauchet, MD, PhD; Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, 49933 Angers cedex 9, France; E-mail: ; Phone: ++33 2 41 35 45 27; Fax: ++33 2 41 35 48 94
| | | | | | | | | |
Collapse
|