Geriatric syndromes predict postdischarge outcomes among older emergency department patients: findings from the interRAI Multinational Emergency Department Study.

• Published in: Academic Emergency Medicine
• Main Authors: Costa, Andrew P, Hirdes, John P, Heckman, George A, Dey, Aparajit B, Jonsson, Palmi V, Lakhan, Prabha, Ljunggren, Gunnar, Singler, Katrin, Sjostrand, Fredrik, Swoboda, Walter, Wellens, Nathalie I H, Gray, Leonard C
• Other Authors: Inst Clin Evaluat Sci, Toronto, ON, Canada, McMaster Univ, Dept Med, Hamilton, ON, Canada, Univ Waterloo, Sch Publ Hlth & Hlth Syst, Waterloo, ON N2L 3G1, Canada, All India Inst Med Sci, Dept Geriatr Med, New Delhi, India, Univ Iceland, Landspitali Univ Hosp, Fac Med, Dept Geriatr, Reykjavik, Iceland, Univ Queensland, Ctr Res Geriatr Med, Brisbane, Qld, Australia, Stockholm Cty Council, Publ Healthcare Serv Comm Adm, Stockholm, Sweden, Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden, Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany, Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden, Sodersjukhuset AB, Sect Emergency Med, Stockholm, Sweden, Katholieke Univ Leuven, Dept Publ Hlth, Ctr Hlth Serv & Nursing Res, Louvain, Belgium, Univ Michigan, Geriatr Ctr, Ann Arbor, MI 48109 USA,Univ Michigan, Inst Gerontol, Ann Arbor, MI 48109 USA
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2015
• Subjects: Aldraðir; Öldrunarmat; Bráðamóttaka; Sjúkrahúsvist; Aged; 80 and over; Australia; Decision Support Techniques; Emergency Service; Hospital; Female; Follow-Up Studies; Frail Elderly; Geriatric Assessment; Hospitalization; Humans; Length of Stay; Logistic Models; Male; Odds Ratio; Outcome Assessment (Health Care); Patient Discharge; Patient Readmission; Prospective Studies; Risk Assessment; Syndrome; Canada; Iceland
• Online Access: http://hdl.handle.net/2336/550705; https://doi.org/10.1111/acem.12353

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. 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. 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. 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 ...