Unplanned early return to the emergency department by older patients

The Safe Elderly Emergency Department Discharge (SEED) project

Research output: Contribution to journalArticleResearchpeer-review

16 Citations (Scopus)

Abstract

Background:an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives:to determine factors associated with early re-presentation. Methods:prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) represented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.

Original languageEnglish
Article numberafv198
Pages (from-to)255-261
Number of pages7
JournalAge and Ageing
Volume45
Issue number2
DOIs
Publication statusPublished - 1 Mar 2016

Keywords

  • Emergency department
  • Older age
  • Older people
  • Re-presentation risk

Cite this

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title = "Unplanned early return to the emergency department by older patients: The Safe Elderly Emergency Department Discharge (SEED) project",
abstract = "Background:an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives:to determine factors associated with early re-presentation. Methods:prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6{\%}) represented within 30 days, including 22 patients (2.3{\%}) on ≥2 occasions and 75 patients (7.8{\%}) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95{\%} CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95{\%} CI 1.09-3.90), previous ED visit (OR 2.11, 95{\%} CI 1.43-3.12) and ATS 4 (OR 2.34, 95{\%} CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95{\%} CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.",
keywords = "Emergency department, Older age, Older people, Re-presentation risk",
author = "Judy Lowthian and Straney, {Lahn D.} and Brand, {Caroline A.} and Barker, {Anna L.} and {De Villiers Smit}, P. and Harvey Newnham and Peter Hunter and Cathie Smith and Cameron, {Peter A.}",
year = "2016",
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doi = "10.1093/ageing/afv198",
language = "English",
volume = "45",
pages = "255--261",
journal = "Age and Ageing",
issn = "0002-0729",
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T1 - Unplanned early return to the emergency department by older patients

T2 - The Safe Elderly Emergency Department Discharge (SEED) project

AU - Lowthian, Judy

AU - Straney, Lahn D.

AU - Brand, Caroline A.

AU - Barker, Anna L.

AU - De Villiers Smit, P.

AU - Newnham, Harvey

AU - Hunter, Peter

AU - Smith, Cathie

AU - Cameron, Peter A.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background:an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives:to determine factors associated with early re-presentation. Methods:prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) represented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.

AB - Background:an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives:to determine factors associated with early re-presentation. Methods:prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) represented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.

KW - Emergency department

KW - Older age

KW - Older people

KW - Re-presentation risk

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U2 - 10.1093/ageing/afv198

DO - 10.1093/ageing/afv198

M3 - Article

VL - 45

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EP - 261

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

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