Elderly face increased disability risk after emergency room visits

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(Daily Focus Today Wednesday 1 February 2017)

Elderly face increased disability risk after emergency room visits

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Published: 4:00 AM, February 1, 2017

NEW YORK — Elderly patients who get treated for illnesses or injuries in the emergency department (ED) are at risk of increased disability for up to six months afterward, a recent study suggests.

To look at how ED visits might relate to functioning once patients go home, researchers examined data on 754 elderly patients who went to the ED without being admitted to the hospital and another 813 similar people who did not visit the ED.

At the start of the study, they had comparable functional abilities, with both groups scoring fairly low on a disability scale. But those who had an ED visit scored an average of 14 per cent higher on the same scale over the next six months, researchers report in the Annals of Emergency Medicine.

“The higher risk of disability following emergency department visits is likely related to the illness or injury that led these patients to seek care in the emergency department,” said study co-author Dr William Fleischman, an emergency medicine researcher at the University of Maryland in Baltimore.

“This does not mean that these patients should have avoided the emergency department or that they should have been hospitalised,” Dr Fleischman, who completed the study as a researcher at Yale University, added by email. “Rather, it suggests that older adults who are medically appropriate for discharge from the emergency department may benefit from the kind of discharge planning that often occurs in the inpatient setting.”

For the 14-year study, participants completed home-based assessments every 18 months and were also interviewed monthly to reassess their functional status, identify any illnesses or injuries leading to ED visits or hospitalisations and identify nursing home admissions and deaths.

Participants were about 84 years old on average when they joined the study, and they were all living in the community, not in institutional settings like nursing homes or assisted living facilities.

Disability was measured on a scale of zero to 13, with higher scores indicating poorer functioning on basic tasks of daily living like dressing and walking, as well as more complex tasks like meal preparation, driving and managing finances.

In addition to rising disability scores, researchers found that people who had ED visits were more than three times likely as those who did not to be admitted to nursing homes within the next six months, and they were almost twice as likely to die.

People who were admitted to the hospital after an ED visit tended to fare even worse.

Hospitalised patients’ average disability scores were 17 per cent higher than scores of patients seen in the ED and sent home, the study found. These hospitalised patients also had the highest risk of nursing home admissions and death.

One limitation of the study is that it only included patients insured by one health plan in a small urban area.

The study was not a controlled experiment designed to prove whether ED visits or hospital admissions directly cause a decline in functioning for elderly people, or why, the authors also note.

Still, the results should be a red flag to watch elderly patients closely when they are sent home from the ED or the hospital, said Dr Amy Kelley, a geriatrics researcher at Icahn School of Medicine at Mount Sinai in New York, who was not involved in the study. REUTERS