Original Contributions
Early revisit, hospitalization, or death among older persons discharged from the ED*,**

Presented in part at the annual meetings of the Society of Academic Emergency Medicine, Chicago, IL, May 1997; the Society of General Internal Medicine, Washington, DC, May 1997; and the Chicago Health Services Research Symposium, Chicago, IL, January 1997.
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Abstract

The purpose of this study to determine predictors of revisit, hospital admission, or death among older patients discharged from the emergency department (ED). We performed a prospective study of patients aged 65 or older in an urban ED. The primary outcomes were ED revisit, hospital admission, or death 30 or 90 days after discharge from an index ED visit. Of the 463 eligible patients, 75 (16%) experienced ED revisit, hospitalization, or death within 30 days, and 125 (27%) within 90 days. In multivariate proportional hazards models, physical functioning and mental health in the lowest tertile, and lack of supplemental insurance predicted revisit, hospitalization, or death within 30 days after ED discharge. Poor physical functioning, missing mini-mental state examination, comorbidity, and ambulance transport to the initial ED visit predicted 90-day outcome. Problems with physical functioning, mental health and supplemental insurance are potentially remediable precursors of early morbidity among older patients after ED discharge. Future research should examine whether addressing these issues among the elderly population will lessen ED return visits, hospitalization, and mortality. (Am J Emerg Med 2001;19:125-129. Copyright © 2001 by W.B. Saunders Company)

Section snippets

Study population

The Institutional Review Board of the University of Chicago approved the study. As previously described,10 research assistants attempted to approach all patients aged 65 or older who presented to the ED of the University of Chicago from October 16, 1995 to June 1, 1996. Because earlier pilot work suggested that few elderly patients present after midnight, enrollment was limited to patients who presented between the hours of 8 am and 12 midnight, 6 days per week, with random selection of the day

Characteristics of the sample

Of the 463 patients discharged from the ED, 346 (75%) completed the initial interview themselves, 34 (7%) participated in the initial interview with help from a proxy, and 83 (18%) were too ill or cognitively impaired to participate so a proxy completed the initial interview. Among these patients, 47% were older than 75 years, 63% were women and 84% were African American (Table 1).

. Characteristics of Patients Discharged From the ED (N = 463)

CharacteristicsDischarged from ED, N (%)
Age, years
 65 to

Discussion

We found that poor physical functioning, poor mental health, and lack of supplemental insurance were multivariate predictors of morbid events among older adults within 30 days of discharge from the ED. Physical functioning is a well-established predictor of outcomes among elderly patients.4, 20 A previous analysis of these data suggested that deficiencies in ADLs were associated with poor recovery after an ED visit.10 Mental health problems have also been implicated in increased morbidity and

Acknowledgements

The authors thank Annette Miller, RN and Michael Nerney for stewarding the data collection effort.

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    *

    Supported by grants from the Chicago Community Trust (no. 12212) and Retirement Research Foundation (no. 95-122). Drs Friedmann and Chin are Robert Wood Johnson Generalist Physician Faculty Scholars. Dr Friedmann is also supported by grant no. K08-DA00320 from the National Institute on Drug Abuse. Dr Chin was supported by grant no. K12-AG00488 from the National Institute on Aging Geriatric Academic Program.

    **

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