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Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department
Author(s) -
Gelder Jelle,
Lucke Jacinta A.,
Groot Bas,
Fogteloo Anne J.,
Anten Sander,
Heringhaus Christian,
Dekkers Olaf M.,
Blauw Gerard J.,
Mooijaart Simon P.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15301
Subject(s) - medicine , interquartile range , emergency department , hazard ratio , polypharmacy , confidence interval , odds ratio , propensity score matching , geriatrics , prospective cohort study , gerontology , demography , pediatrics , psychiatry , sociology
Objectives To study predictors of emergency department (ED) revisits and the association between ED revisits and 90‐day functional decline or mortality. Design Multicenter cohort study. Setting One academic and two regional Dutch hospitals. Participants Older adults discharged from the ED (N=1,093). Measurements At baseline, data on demographic characteristics, illness severity, and geriatric parameters (cognition, functional capacity) were collected. All participants were prospectively followed for an unplanned revisit within 30 days and for functional decline and mortality 90 days after the initial visit. Results The median age was 79 (interquartile range 74–84), and 114 participants (10.4%) had an ED revisit within 30 days of discharge. Age (hazard ratio (HR)=0.96, 95% confidence interval (CI)=0.92–0.99), male sex (HR=1.61, 95% CI=1.05–2.45), polypharmacy (HR=2.06, 95% CI=1.34–3.16), and cognitive impairment (HR=1.71, 95% CI=1.02–2.88) were independent predictors of a 30‐day ED revisit. The area under the receiver operating characteristic curve to predict an ED revisit was 0.65 (95% CI=0.60–0.70). In a propensity score–matched analysis, individuals with an ED revisit were at higher risk (odds ratio=1.99 95% CI=1.06–3.71) of functional decline or mortality. Conclusion Age, male sex, polypharmacy, and cognitive impairment were independent predictors of a 30‐day ED revisit, but no useful clinical prediction model could be developed. However, an early ED revisit is a strong new predictor of adverse outcomes in older adults.