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Risk Factors for Disability After Emergency Department Discharge in Older Adults
Author(s) -
Nagurney Justine M.,
Han Ling,
LeoSummers Linda,
Allore Heather G.,
Gill Thomas M.
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.14088
Subject(s) - medicine , emergency department , confidence interval , relative risk , longitudinal study , gerontology , physical therapy , demography , psychiatry , pathology , sociology
Objectives We have previously shown that older adults discharged from the emergency department (ED) experience an increased disability burden within a 6‐month time period after ED discharge. The objective of this study was to identify risk factors associated with increased disability burden among older adults discharged from the ED. Methods This study is part of an ongoing longitudinal study of 754 community‐living persons aged ≥70 years. The analytic sample included 813 ED visits without hospitalization from 430 participants who had at least one visit to an ED during a 14‐year follow‐up period (1998–2012). Information on ED visits and disability burden in 13 functional activities was collected during monthly interviews. Twenty‐nine candidate risk factors were evaluated for their independent associations with increased disability burden using a longitudinal multivariable model. Results In the multivariable analyses, age ≥85 (adjusted risk ratio [aRR] = 1.14, 95% confidence interval [CI] = 1.05 to 1.24), being unmarried (aRR = 1.15, 95% CI = 1.05 to 1.27), lower‐extremity weakness (aRR = 1.20, 95% CI = 1.07 to 1.34), and physical frailty (aRR = 1.25, 95% CI = 1.13 to 1.37) were associated with increased disability burden. As the number of risk factors increased, the predicted mean disability burden (on a scale of 0 to 13) also increased, ranging from a value of 1.80 (95% CI = 1.43 to 2.27) for 0 risk factors to a value of 8.59 (95% CI = 7.93 to 9.29) for four risk factors. Conclusions Among older adults discharged from the ED, several risk factors were associated with increased disability burden over the following 6 months, including age ≥85, being unmarried, lower‐extremity weakness, and physical frailty. Further research is needed to evaluate whether risk stratification based on nonmodifiable factors or interventions targeting modifiable risk factors improve functional outcomes for older adults discharged from the ED.