Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study

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 s...

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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.
Format: Article in Journal/Newspaper
Language:unknown
Published: Wiley Periodicals, Inc. 2014
Subjects:
Medicine (General)
Health Sciences
Canada
Iceland
Online Access:http://hdl.handle.net/2027.42/106886
https://doi.org/10.1111/acem.12353
id ftumdeepblue:oai:deepblue.lib.umich.edu:2027.42/106886
record_format openpolar
institution Open Polar
collection University of Michigan: Deep Blue
op_collection_id ftumdeepblue
language unknown
topic Medicine (General)
Health Sciences
spellingShingle Medicine (General)
Health Sciences
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.
Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
topic_facet Medicine (General)
Health Sciences
description 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 inter RAI 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 ( OR s) 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 = ...
format Article in Journal/Newspaper
author 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.
author_facet 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.
author_sort Costa, Andrew P.
title Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
title_short Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
title_full Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
title_fullStr Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
title_full_unstemmed Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study
title_sort geriatric syndromes predict postdischarge outcomes among older emergency department patients: findings from the interrai multinational emergency department study
publisher Wiley Periodicals, Inc.
publishDate 2014
url http://hdl.handle.net/2027.42/106886
https://doi.org/10.1111/acem.12353
geographic Canada
geographic_facet Canada
genre Iceland
genre_facet Iceland
op_relation 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. (2014). "Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study." Academic Emergency Medicine (4): 422-433.
1069-6563
1553-2712
http://hdl.handle.net/2027.42/106886
doi:10.1111/acem.12353
Academic Emergency Medicine
Salvi F, Morichi V, Grilli A, et al. Predictive validity of the identification of seniors at risk (ISAR) screening tool in elderly patients presenting to two Italian emergency departments. Aging Clin Exp Res 2009; 21: 69 – 75.
Hitcho EB, Krauss MJ, Birge S, et al. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004; 19: 732 – 9.
Graf CE, Giannelli SV, Herrmann FR, et al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department–comparison of two screening tools. Swiss Med Wkly 2012; 141: w13327.
Lee JS, Schwindt G, Langevin M, et al. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Geriatr Soc 2008; 56: 2112 – 7.
Hosmer DW, Lemeshow S. Applied Logistic Regression, 2nd ed. New York, NY: Wiley and Sons, 2000.
King JE. Running a best‐subsets logistic regression: an alternative to stepwise methods. Educ Psychol Meas 2003; 63: 392 – 403.
von Elm E. Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344 – 9.
Buurman BM, van den Berg W, Korevaar JC, Milisen K, de Haan RJ, de Rooij SE. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments. Eur J Emerg Med 2011; 18: 215 – 20.
Fan J, Worster A, Fernandes CM. Predictive validity of the triage risk screening tool for elderly patients in a Canadian emergency department. Am J Emerg Med 2006; 24: 540 – 4.
LaMantia MA, Platts‐Mills TF, Biese K, et al. Predicting hospital admission and returns to the emergency department for elderly patients. Acad Emerg Med 2010; 17: 252 – 9.
Moons P, De Ridder K, Geyskens K, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14: 315 – 23.
Carpenter CR, Heard K, Wilber S, et al. Research priorities for high‐quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med 2011; 18: 644 – 54.
Wilber ST, Gerson LW. A research agenda for geriatric emergency medicine. Acad Emerg Med 2003; 10: 251 – 60.
Biese KJ, Roberts E, LaMantia M, et al. Effect of a geriatric curriculum on emergency medicine resident attitudes, knowledge, and decision‐making. Acad Emerg Med 2011; 18 ( Suppl 2 ): S92 – 6.
Jónsson PV, Noro A, Finne‐Soveri H, et al. Admission profile is predictive of outcome in acute hospital care. Aging Clin Exp Res 2008; 20: 533 – 9.
Lakhan P, Jones M, Wilson A, Gray LC. The higher care at discharge index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge. Arch Gerontol Geriatr 2013; 57: 184 – 91.
Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short‐term hip fracture outcomes. Arch Intern Med 2009; 169: 1712 – 7.
Kates SL, Mendelson DA, Friedman SM. The value of an organized fracture program for the elderly: early results. J Orthop Trauma 2011; 25: 233 – 7.
Inouye SK, Bogardus ST, Baker DI, Leo‐Summers L, Cooney LM. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital elder life program. J Am Geriatr Soc 2000; 48: 1697 – 706.
Crane SJ, Tung EE, Hanson GJ, Cha S, Chaudhry R, Takahashi PY. Use of an electronic administrative database to identify older community dwelling adults at high‐risk for hospitalization or emergency department visits: the elders risk assessment index. BMC Health Serv Res 2010; 10: 338.
Shelton P, Sager MA, Schraeder C. The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit. Am J Manag Care 2000; 6: 925 – 33.
Joubert L, Lee J, McKeever U, Holland L. Caring for depressed elderly in the emergency department: establishing links between sub‐acute, primary, and community care. Soc Work Health Care 2013; 52: 222 – 38.
Raccio‐Robak N, McErlean MA, Fabacher DA, Milano PM, Verdile VP. Socioeconomic and health status differences between depressed and nondepressed ED elders. Am J Emerg Med 2002; 20: 71 – 3.
Brokaw M, Zaraa AS. A biopsychosocial profile of the geriatric population who frequently visit the emergency department. Ohio Med 1991; 87: 347 – 50.
Borges Da Silva R, McCusker J, Roberge D, et al. Classification of emergency departments according to their services for community‐dwelling seniors. Acad Emerg Med 2012; 19: 552 – 61.
McCusker J, Roberge D, Ciampi A, et al. Outcomes of community‐dwelling seniors vary by type of emergency department. Acad Emerg Med 2012; 19: 304 – 12.
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780 – 91.
Gray LC, Peel N, Costa AP, et al. Profiles of older patients in the emergency department: findings from the interRAI multinational emergency department study. Ann Emerg Med 2013; 62: 467 – 74.
Keim S, Sanders A. Geriatric emergency department use and care. In: Meldon S, Ma OJ, Woolard RH, eds. Geriatric Emergency Medicine. New York, NY: McGraw‐Hill, 2004: 1 – 3.
McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med 1992; 21: 796 – 801.
Sanders AB. Care of the elderly in emergency departments: conclusions and recommendations. Ann Emerg Med 1992; 21: 830 – 4.
Schumacher JG. Emergency medicine and older adults: continuing challenges and opportunities. Am J Emerg Med 2005; 23: 556 – 60.
Schumacher JG, Deimling GT, Meldon S, Woolard B. Older adults in the emergency department: predicting physicians' burden levels. J Emerg Med 2006; 30: 455 – 60.
Wilber ST, Blanda M, Gerson LW. Does functional decline prompt emergency department visits and admission in older patients? Acad Emerg Med 2006; 13: 680 – 2.
Nemec M, Koller MT, Nickel CH, et al. Patients presenting to the emergency department with non‐specific complaints: the Basel non‐specific complaints (BANC) study. Acad Emerg Med 2010; 17: 284 – 92.
Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly 2005; 135: 145 – 50.
Ferrera PC, Bartfield JM, D'Andrea CC. Geriatric trauma: outcomes of elderly patients discharged from the ED. Am J Emerg Med 1999; 17: 629 – 32.
Russell MA, Hill KD, Blackberry I, Day LL, Dharmage SC. Falls risk and functional decline in older fallers discharged directly from emergency departments. J Gerontol A Biol Sci Med Sci 2006; 61: 1090 – 5.
Shapiro MJ, Partridge RA, Jenouri I, Micalone M, Gifford D. Functional decline in independent elders after minor traumatic injury. Acad Emerg Med 2001; 8: 78 – 81.
Carpenter CR, Griffey RT, Stark S, Coopersmith CM, Gage BF. Physician and nurse acceptance of technicians to screen for geriatric syndromes in the emergency department. West J Emerg Med 2011; 12: 489 – 95.
Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ 2000; 163: 977 – 81.
Hendriksen H, Harrison RA. Occupational therapy in accident and emergency departments: a randomized controlled trial. J Adv Nurs 2001; 36: 727 – 32.
Hustey FM, Meldon S. Prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med 2002; 39: 248 – 53.
Meldon SW, Emerman CL, Schubert DS, Moffa DA, Etheart RG. Depression in geriatric ED patients: prevalence and recognition. Ann Emerg Med 1997; 30: 141 – 5.
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spelling ftumdeepblue:oai:deepblue.lib.umich.edu:2027.42/106886 2023-08-20T04:07:32+02:00 Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study 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. 2014-04 application/pdf http://hdl.handle.net/2027.42/106886 https://doi.org/10.1111/acem.12353 unknown Wiley Periodicals, Inc. McGraw‐Hill 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. (2014). "Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study." Academic Emergency Medicine (4): 422-433. 1069-6563 1553-2712 http://hdl.handle.net/2027.42/106886 doi:10.1111/acem.12353 Academic Emergency Medicine Salvi F, Morichi V, Grilli A, et al. Predictive validity of the identification of seniors at risk (ISAR) screening tool in elderly patients presenting to two Italian emergency departments. Aging Clin Exp Res 2009; 21: 69 – 75. Hitcho EB, Krauss MJ, Birge S, et al. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004; 19: 732 – 9. Graf CE, Giannelli SV, Herrmann FR, et al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department–comparison of two screening tools. Swiss Med Wkly 2012; 141: w13327. Lee JS, Schwindt G, Langevin M, et al. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Geriatr Soc 2008; 56: 2112 – 7. Hosmer DW, Lemeshow S. Applied Logistic Regression, 2nd ed. New York, NY: Wiley and Sons, 2000. King JE. Running a best‐subsets logistic regression: an alternative to stepwise methods. Educ Psychol Meas 2003; 63: 392 – 403. von Elm E. Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344 – 9. Buurman BM, van den Berg W, Korevaar JC, Milisen K, de Haan RJ, de Rooij SE. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments. Eur J Emerg Med 2011; 18: 215 – 20. Fan J, Worster A, Fernandes CM. Predictive validity of the triage risk screening tool for elderly patients in a Canadian emergency department. Am J Emerg Med 2006; 24: 540 – 4. LaMantia MA, Platts‐Mills TF, Biese K, et al. Predicting hospital admission and returns to the emergency department for elderly patients. Acad Emerg Med 2010; 17: 252 – 9. Moons P, De Ridder K, Geyskens K, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14: 315 – 23. Carpenter CR, Heard K, Wilber S, et al. Research priorities for high‐quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med 2011; 18: 644 – 54. Wilber ST, Gerson LW. A research agenda for geriatric emergency medicine. Acad Emerg Med 2003; 10: 251 – 60. Biese KJ, Roberts E, LaMantia M, et al. Effect of a geriatric curriculum on emergency medicine resident attitudes, knowledge, and decision‐making. Acad Emerg Med 2011; 18 ( Suppl 2 ): S92 – 6. Jónsson PV, Noro A, Finne‐Soveri H, et al. Admission profile is predictive of outcome in acute hospital care. Aging Clin Exp Res 2008; 20: 533 – 9. Lakhan P, Jones M, Wilson A, Gray LC. The higher care at discharge index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge. Arch Gerontol Geriatr 2013; 57: 184 – 91. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short‐term hip fracture outcomes. Arch Intern Med 2009; 169: 1712 – 7. Kates SL, Mendelson DA, Friedman SM. The value of an organized fracture program for the elderly: early results. J Orthop Trauma 2011; 25: 233 – 7. Inouye SK, Bogardus ST, Baker DI, Leo‐Summers L, Cooney LM. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital elder life program. J Am Geriatr Soc 2000; 48: 1697 – 706. Crane SJ, Tung EE, Hanson GJ, Cha S, Chaudhry R, Takahashi PY. Use of an electronic administrative database to identify older community dwelling adults at high‐risk for hospitalization or emergency department visits: the elders risk assessment index. BMC Health Serv Res 2010; 10: 338. Shelton P, Sager MA, Schraeder C. The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit. Am J Manag Care 2000; 6: 925 – 33. Joubert L, Lee J, McKeever U, Holland L. Caring for depressed elderly in the emergency department: establishing links between sub‐acute, primary, and community care. Soc Work Health Care 2013; 52: 222 – 38. Raccio‐Robak N, McErlean MA, Fabacher DA, Milano PM, Verdile VP. Socioeconomic and health status differences between depressed and nondepressed ED elders. Am J Emerg Med 2002; 20: 71 – 3. Brokaw M, Zaraa AS. A biopsychosocial profile of the geriatric population who frequently visit the emergency department. Ohio Med 1991; 87: 347 – 50. Borges Da Silva R, McCusker J, Roberge D, et al. Classification of emergency departments according to their services for community‐dwelling seniors. Acad Emerg Med 2012; 19: 552 – 61. McCusker J, Roberge D, Ciampi A, et al. Outcomes of community‐dwelling seniors vary by type of emergency department. Acad Emerg Med 2012; 19: 304 – 12. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780 – 91. Gray LC, Peel N, Costa AP, et al. Profiles of older patients in the emergency department: findings from the interRAI multinational emergency department study. Ann Emerg Med 2013; 62: 467 – 74. Keim S, Sanders A. Geriatric emergency department use and care. In: Meldon S, Ma OJ, Woolard RH, eds. Geriatric Emergency Medicine. New York, NY: McGraw‐Hill, 2004: 1 – 3. McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med 1992; 21: 796 – 801. Sanders AB. Care of the elderly in emergency departments: conclusions and recommendations. Ann Emerg Med 1992; 21: 830 – 4. Schumacher JG. Emergency medicine and older adults: continuing challenges and opportunities. Am J Emerg Med 2005; 23: 556 – 60. Schumacher JG, Deimling GT, Meldon S, Woolard B. Older adults in the emergency department: predicting physicians' burden levels. J Emerg Med 2006; 30: 455 – 60. Wilber ST, Blanda M, Gerson LW. Does functional decline prompt emergency department visits and admission in older patients? Acad Emerg Med 2006; 13: 680 – 2. Nemec M, Koller MT, Nickel CH, et al. Patients presenting to the emergency department with non‐specific complaints: the Basel non‐specific complaints (BANC) study. Acad Emerg Med 2010; 17: 284 – 92. Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly 2005; 135: 145 – 50. Ferrera PC, Bartfield JM, D'Andrea CC. Geriatric trauma: outcomes of elderly patients discharged from the ED. Am J Emerg Med 1999; 17: 629 – 32. Russell MA, Hill KD, Blackberry I, Day LL, Dharmage SC. Falls risk and functional decline in older fallers discharged directly from emergency departments. J Gerontol A Biol Sci Med Sci 2006; 61: 1090 – 5. Shapiro MJ, Partridge RA, Jenouri I, Micalone M, Gifford D. Functional decline in independent elders after minor traumatic injury. Acad Emerg Med 2001; 8: 78 – 81. Carpenter CR, Griffey RT, Stark S, Coopersmith CM, Gage BF. Physician and nurse acceptance of technicians to screen for geriatric syndromes in the emergency department. West J Emerg Med 2011; 12: 489 – 95. Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ 2000; 163: 977 – 81. Hendriksen H, Harrison RA. Occupational therapy in accident and emergency departments: a randomized controlled trial. J Adv Nurs 2001; 36: 727 – 32. Hustey FM, Meldon S. Prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med 2002; 39: 248 – 53. Meldon SW, Emerman CL, Schubert DS, Moffa DA, Etheart RG. Depression in geriatric ED patients: prevalence and recognition. Ann Emerg Med 1997; 30: 141 – 5. IndexNoFollow Medicine (General) Health Sciences Article 2014 ftumdeepblue https://doi.org/10.1111/acem.12353 2023-07-31T20:33:04Z 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 inter RAI 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 ( OR s) 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 = ... Article in Journal/Newspaper Iceland University of Michigan: Deep Blue Canada Academic Emergency Medicine 21 4 422 433

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