Predictive outcomes for older people who present to the emergency department

Crilly, Julia; Chaboyer, Wendy; Wallis, Marianne; Thalib, Lukman; Green, David

doi:10.1016/j.aenj.2008.07.002

« Previous Next »Australasian Emergency Nursing Journal
Volume 11, Issue 4 , Pages 178-183, November 2008

Predictive outcomes for older people who present to the emergency department

Julia Crilly, RN, PhD
- Emergency Department, Gold Coast Hospital, Qld, Australia
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Qld, Australia
- Corresponding author at: Emergency Department, Gold Coast Hospital, Southport Campus, 108 Nerang Street, Southport, Queensland 4215, Australia. Tel.: +61 7 55 197754; fax: +61 7 55 198313.
Wendy Chaboyer, RN, PhD
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Qld, Australia
Marianne Wallis, RN, PhD
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Qld, Australia
- Nursing Education and Research Unit, Gold Coast Health Service District, Qld, Australia
Lukman Thalib, PhD
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Qld, Australia
- Department of Community Medicine (Biostatistics), Kuwait University, Kuwait
David Green, MBBS, FACEM
- Emergency Department, Gold Coast Hospital, Qld, Australia

Received 20 May 2008; received in revised form 15 July 2008; accepted 20 July 2008.

Summary

Background

In an ageing population, older people comprise an increasingly higher proportion of emergency department (ED) presentations. When admitted to hospital, some elderly patients (particularly aged care facility residents) are at risk of iatrogenic complications.

Method

A retrospective cohort study was conducted to describe clinical characteristics and predict outcomes of 6208 patients aged ≥65 years who presented to one emergency department (ED) from 1 July 2002 to 30 June 2003. Internal comparisons of aged care facility residents (ACFRs) and non-aged care facility residents (non-ACFRs) were performed. Outcome measures included length of stay (LOS) (ED and hospital), ED re-presentation, hospital readmission and in-hospital mortality.

Results

1006 ACFRs and 5202 non-ACFRs presented to the ED within 12 months. Compared to non-ACFRs, ACFRs comprised significantly higher proportions of admission (76.6% vs. 60.8%), ED re-presentation (66.0% vs. 52.0%) and hospital readmission (36.5% vs. 24.7%). ACFRs also had a significantly longer ED LOS (6h vs. 5h) and hospital LOS (5 days vs. 3 days). Multivariate analysis revealed that ACFR was an independent predictor of an ED LOS of >6h (OR 1.71, 95% CI 1.54–1.92, p<0.001), re-presentation to the ED (OR 1.67, 95% CI 1.45–1.93, p<0.001), hospital LOS of > 6 days (OR 1.31, 95% CI 1.13–1.51) and hospital readmission (OR 1.76, 95% CI 1.49–2.07).

Conclusions

Older people presenting to the ED, particularly ACFRs, are a group susceptible to negative hospital related outcomes. These outcomes should be considered by health service planners given the expected growth in the older population and subsequent need for acute medical services.

Keywords: Emergency, Emergency service, Older people, Aged, Nursing homes