Unscheduled return visits to the emergency department (ED) represent a considerable segment of older adults' total visits to the ED. This study explores the factors that led to early return visits to the ED by older adults. Using a qualitative descriptive design, semi-structured interviews were conducted in a large teaching hospital with 15 older adults who returned to the ED within 2 weeks after an initial visit. From the interviews, three major themes emerged as precipitants that led older adults to return to the ED. These were Managing the Symptoms, Care Curing the Initial ED Visit, and Who I Am. The findings suggest that the main reason for older adults' return to the ED is the severity of the symptoms they experienced. Ensuring the timeliness of follow-up appointments and the provision of resources to support the transition home are identified as interventions that would improve the care provided in EDs.

BackgroundThe optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients.MethodsThis study is a retrospective cohort analysis of patients admitted to the rehabilitation program of our GDH, in Montreal, Canada, over a five year period. The measures considered were: Barthel Index, Older Americans Resources and Services, Folstein Mini Mental Status Exam, Timed Up & Go (TUG), 6-minute walk test (6 MWT), Gait speed, Berg Balance, grip strength and the European Quality of life - 5 Dimensions. Successful improvement with rehabilitation was defined as improvement in three or more tests of physical function. Logistic regression analysis using the Bayesian Information Criterion (BIC) was employed to select the optimal model for making predictions of rehabilitation success.ResultsA total of 335 patients were studied, but only 233 patients had a complete data set suitable for the predictive model. Average age was 81 years and patients attended the GDH an average of 24 visits. Significant changes were found in several measures of physical performance for many patients ranging from improved gait speed in 21.3% to improved TUG in 62.7% of the cohort. Fifty-eight percent of patients attained successful improvement with rehabilitation by our criteria. This group was characterized by lower test scores on admission. Using BIC, the best predictor model was the 6 MWT [OR: 0.994 per meter walked (95% CI: 0.990-0.997)].ConclusionsThe GDH rehabilitation program is effective in improving patients' physical performance. Although no single measure was found to be sufficiently predictive to help target candidates appropriately, the 6 MWT showed a trend to significance. Further research will be done to elucidate the utility of a composite 'rehab appropriateness index' and the role of International Classification of Function concepts for targeting frail elderly to GDH rehabilitation services.