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Gettel CJ, Galske J, Sather AR, Haidous AK, Hwang U, Brackett AL, Venkatesh AK, Rising KL, Goldberg EM, van Oppen JD, Conroy SP, Carpenter CR. Patient-reported outcome measure use among older adults after emergency department care: A systematic review. Acad Emerg Med 2024; 31:273-287. [PMID: 38366698 DOI: 10.1111/acem.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are gaining favor in clinical and research settings given their ability to capture a patient's symptom burden, functional status, and quality of life. Our objective in this systematic review was to summarize studies including PROMs assessed among older adults (age ≥ 65 years) after seeking emergency care. METHODS With the assistance of a medical librarian, we searched Ovid MEDLINE, PubMed, Embase, CINAHL, Web of Science-Core Collection, and Cochrane CENTRAL from inception through June 2023 for studies in which older adult ED patients had PROMs assessed in the post-emergency care time period. Independent reviewers performed title/abstract review, full-text screening, data extraction, study characteristic summarization, and risk-of-bias (RoB) assessments. RESULTS Our search strategy yielded 5153 studies of which 56 met study inclusion criteria. Within included studies, 304 unique PROM assessments were performed at varying time points after the ED visit, including 61 unique PROMs. The most commonly measured domain was physical function, assessed within the majority of studies (47/56; 84%), with measures including PROMs such as Katz activities of daily living (ADLs), instrumental ADLs, and the Barthel Index. PROMs were most frequently assessed at 1-3 months after an ED visit (113/304; 37%), greater than 6 months (91/304; 30%), and 4-6 months (88/304; 29%), with very few PROMs assessed within 1 month of the ED visit (12/304; 4%). Of the 16 interventional studies, two were determined to have a low RoB, four had moderate RoB, nine had high RoB, and one had insufficient information. Of the 40 observational studies, 10 were determined to be of good quality, 20 of moderate quality, and 10 of poor quality. CONCLUSIONS PROM assessments among older adults following an ED visit frequently measured physical function, with very few assessments occurring within the first 1 month after an ED visit.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Galske
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Ali K Haidous
- University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Alexandria L Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - James D van Oppen
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Simon P Conroy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
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Hoang P, King JA, Moore S, Moore K, Reich K, Sidhu H, Tan CV, Whaley C, McMillan J. Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2236676. [PMID: 36251294 PMCID: PMC9577679 DOI: 10.1001/jamanetworkopen.2022.36676] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Loneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality. OBJECTIVE To evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation. DATA SOURCES OVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020. STUDY SELECTION Peer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022. MAIN OUTCOMES AND MEASURES Quantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences. RESULTS Seventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants' ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (-1.86; 95% CI, -3.14 to -0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (-1.40; 95% CI, -2.37 to -0.44; I2 = 70%). CONCLUSIONS AND RELEVANCE In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size's magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.
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Affiliation(s)
- Peter Hoang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James A. King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, Alberta, Canada
- Data and Analytics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sarah Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kim Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Krista Reich
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harman Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chin Vern Tan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Whaley
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacqueline McMillan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Conneely M, Leahy S, Dore L, Trépel D, Robinson K, Jordan F, Galvin R. The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review. BMC Geriatr 2022; 22:462. [PMID: 35643453 PMCID: PMC9145107 DOI: 10.1186/s12877-022-03007-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03007-5.
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Shrestha R, Shrestha AP, Shrestha A, Kamholz B. Unrecognized geriatric depression in the emergency Department of a Teaching Hospital in Nepal: prevalence, contributing factors, and metric properties of 5 item geriatric depression scale in this population. BMC Psychiatry 2020; 20:533. [PMID: 33176730 PMCID: PMC7656752 DOI: 10.1186/s12888-020-02910-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is prevalent but poorly recognized in the Emergency Department (ED). We aimed to identify the frequency of unrecognized geriatric depression and its possible determinants in the ED using the 15-item geriatric depression scale (GDS). We also aimed to explore the performance of the shorter, five-item GDS as compared to the 15-item GDS. METHODS This was a cross-sectional study of the ED patients ≥ 60 years. The previously validated Nepali version of GDS-15 screened the sample into "no", "mild-moderate" and "severe" depression using cutoff values of 4/5, and 8/9 respectively. Demographic and socioeconomic factors, comorbidities and health seeking behaviors were studied and the relation was assessed with binary (Chi-square and Kruskal-Wallis test) and multinomial regression analysis. The performance of GDS-5 was compared with the GDS-15 as standard. Cronbach's alpha was calculated to investigate reliability. Validity was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, Spearman's correlation, receiver operating characteristic curve, and kappa coefficient. RESULTS Two hundred eighty patients were enrolled with an overall prevalence of unrecognized depression of 45.7% [104 (81.3%) mild-moderate depression, and 24 (18.8%) severe depression]. The mean age of the sample was 71.36 with female predominance (61%), and 82.5% were illiterate. In the binary analysis, those who had more pain, visited the ED more often, had musculoskeletal diseases and sleep problems, mobility problems, visited local healers previously, and who reported self-perceived "heart and mind" disease showed statistically significant differences among the three categories. In multinomial regression analysis, visits to local healers, sleep problems and frequency of pain were significantly related to depression. The sensitivity, specificity, area under curve and Spearman's correlation of GDS-5 were 75.8%, 96%, 0.919, and 0.827 respectively. Cronbach's alpha for GDS-5 was low (0.416), therefore a new version was proposed which improved the sensitivity to 90.6% and Cronbach's alpha to 0.623. CONCLUSIONS Unrecognized geriatric depression was highly prevalent which urges the need for ED-based interventions for screening and referral. The proposed brief GDS-5 correlated well with the GDS-15 with better validity and internal reliability and offers a more expeditious form of screening for geriatric depression in emergency settings in Nepal.
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Affiliation(s)
- Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Barbara Kamholz
- Volunteer Clinical Professor of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
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Berning MJ, Oliveira J E Silva L, Suarez NE, Walker LE, Erwin P, Carpenter CR, Bellolio F. Interventions to improve older adults' Emergency Department patient experience: A systematic review. Am J Emerg Med 2020; 38:1257-1269. [PMID: 32222314 DOI: 10.1016/j.ajem.2020.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVE To summarize interventions that impact the experience of older adults in the emergency department (ED) as measured by patient experience instruments. METHODS This is a systematic review to evaluate interventions aimed to improve geriatric patient experience in the ED. We searched Ovid CENTRAL, Ovid EMBASE, Ovid MEDLINE and PsycINFO from inception to January 2019. The main outcome was patient experience measured through instruments to assess patient experience or satisfaction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the confidence in the evidence available. RESULTS The search strategy identified 992 studies through comprehensive literature search and hand-search of reference lists. A total of 21 studies and 3163 older adults receiving an intervention strategy aimed at improve patient experience in the ED were included. Department-wide interventions, including geriatric ED and comprehensive geriatric assessment unit, focused care coordination with discharge planning and referral for community services, were associated with improved patient experience. Providing an assistive listening device to those with hearing loss and having a pharmacist reviewing the medication list showed an improved patient perception of quality of care provided. The confidence in the evidence available for the outcome of patient experience was deemed to be very low. CONCLUSION While all studies reported an outcome of patient experience, there was significant heterogeneity in the tools used to measure it. The very low certainty in the evidence available highlights the need for more reliable tools to measure patient experience and studies designed to measure the effect of the interventions.
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Affiliation(s)
- Michelle J Berning
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Laura E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Patricia Erwin
- Mayo Clinic Libraries, Rochester, MN, United States of America
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, MO, United States of America
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States of America.
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Feng L, Li P, Lu C, Tang W, Mahapatra T, Wang Y, Wang X, Ma Y, Ben Y, Cao X, Mahapatra S, Ling M, Gou A, Wang Y, Xiao J, Hou M, Wang X, Lin B, Chen R, Wang F, Hu Z. Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China. PLoS One 2014; 9:e114139. [PMID: 25437860 PMCID: PMC4250089 DOI: 10.1371/journal.pone.0114139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 11/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background With the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease. Methods A cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS). Results Among these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR = 3.92, 95% CI 1.18–13.03), satisfaction regarding quality of life (AOR = 0.53, 95% CI 0.37–0.84) and income (AOR = 0.75, 95% CI 0.35–1.60), suffering from more chronic diseases (AOR = 1.70, 95% CI 1.42–2.04), experiencing three or more negative events (AOR = 1.72, 95% CI 0.92–3.22) and lack of ability to take self-care (AOR = 2.20, 95% CI 1.09–4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation. Conclusion High prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life.
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Affiliation(s)
- Lei Feng
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ping Li
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Chen Lu
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, Guangdong, 510095, China
| | - Tanmay Mahapatra
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90066, United States of America
| | - Yu Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xihua Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ying Ma
- Anhui medical university, Hefei, Anhui, 230032, China
| | - Yanli Ben
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xiaolin Cao
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Sanchita Mahapatra
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90066, United States of America
| | - Min Ling
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Anshuan Gou
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Yanmei Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Jiangqin Xiao
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ming Hou
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Xiuli Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Bo Lin
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
| | - Ruoling Chen
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1DT, United Kingdom
| | - Faxing Wang
- The people's hospital of Xinjiang Uyghur autonomous region, Urumqi, Xinjiang, 830000, China
- * E-mail: (FW); (ZH)
| | - Zhi Hu
- Anhui medical university, Hefei, Anhui, 230032, China
- * E-mail: (FW); (ZH)
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Costa AP, Hirdes JP, Heckman GA, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Singler K, Sjostrand F, Swoboda W, Wellens NI, Gray LC. Geriatric syndromes predict postdischarge outcomes among older emergency department patients: findings from the interRAI Multinational Emergency Department Study. Acad Emerg Med 2014; 21:422-33. [PMID: 24730405 DOI: 10.1111/acem.12353] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/22/2013] [Accepted: 10/26/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for preventative interventions. Previous studies have used single-country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context. METHODS A multinational prospective cohort study of ED patients aged 75 years or older was conducted. A total of 13 ED sites from Australia, Belgium, Canada, Germany, Iceland, India, and Sweden participated. Patients who were expected to die within 24 hours or did not speak the native language were excluded. Of the 2,475 patients approached for inclusion, 2,282 (92.2%) were enrolled. Patients were assessed at ED admission with the interRAI ED Contact Assessment, a geriatric ED assessment. Outcomes were examined for patients admitted to a hospital ward (62.9%, n=1,436) or discharged to a community setting (34.0%, n=775) after an ED visit. Overall, 3% of patients were lost to follow-up. Hospital length of stay (LOS) and discharge to higher level of care was recorded for patients admitted to a hospital ward. Any ED or hospital use within 28 days of discharge was recorded for patients discharged to a community setting. Unadjusted and adjusted odds ratios (ORs) were used to describe determinants using standard and multilevel logistic regression. RESULTS A multi-country model including living alone (OR=1.78, p≤0.01), informal caregiver distress (OR=1.69, p=0.02), deficits in ambulation (OR=1.94, p≤0.01), poor self-report (OR = 1.84, p≤0.01), and traumatic injury (OR=2.18, p≤0.01) best described older patients at risk of longer hospital lengths of stay. A model including recent ED visits (OR=2.10, p≤0.01), baseline functional impairment (OR=1.68, p≤0.01), and anhedonia (OR=1.73, p≤0.01) best described older patients at risk of proximate repeat hospital use. A sufficiently accurate and generalizable model to describe the risk of discharge to higher levels of care among admitted patients was not achieved. CONCLUSIONS Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.
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Affiliation(s)
- Andrew P. Costa
- The Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- The Department of Medicine; McMaster University; Hamilton Ontario Canada
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - John P. Hirdes
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - George A. Heckman
- The Department of Medicine; McMaster University; Hamilton Ontario Canada
- The School of Public Health and Health Systems; University of Waterloo; Waterloo Ontario Canada
| | - Aparajit B. Dey
- The Department of Geriatric Medicine; All India Institute of Medical Sciences; New Delhi India
| | - Palmi V. Jonsson
- The Department of Geriatrics; Landspitali University Hospital; Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - Prabha Lakhan
- The Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Gunnar Ljunggren
- The Medical Management Centre; Department of Learning, Informatics; Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Katrin Singler
- The Institute for Biomedicine of Aging; University of Erlangen-Nuremberg; Klinikum Nuremberg Germany
| | - Fredrik Sjostrand
- Karolinska Institutet; Department of Clinical Science and Education; Södersjukhuset, and the Section of Emergency Medicine; Södersjukhuset AB Stockholm Sweden
| | - Walter Swoboda
- The Institute for Biomedicine of Aging; University of Erlangen-Nuremberg; Klinikum Nuremberg Germany
| | - Nathalie I.H. Wellens
- The Department of Public Health; Centre for Health Services and Nursing Research; KU Leuven Belgium
- The Geriatrics Center and Institute of Gerontology; University of Michigan; Ann Arbor MI
| | - Leonard C. Gray
- The Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane Queensland Australia
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