Risk Factors Associated with Emergency Department Recidivism in the Older Adult

Sheikh, Sophia

doi:10.5811/westjem.2019.7.43073

Cited by 21 publications

(23 citation statements)

References 37 publications

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“…Our findings are also contrary to the literature demonstrating that advancing age, in general, increases the odds of ED returns in older adults [1,3,24]. In a study of the general ED population within the United States, patients over 65 years of age were three times more likely to return and to be hospitalized within 72 hours of an ED visit compared with those under age 30 and twice as likely as those under age 46.…”

Section: Age As a Predictor For Pain-related Returnscontrasting

confidence: 99%

“…Older adults are more likely to return to the emergency department (ED) compared with younger adults [1,2]. Numerous studies have identified risk factors for ED returns in older adults [3]. Features that may contribute to ED recidivism include poor health literacy, poor cognitive health, chronic comorbid conditions, and lack of social support [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

et al. 2020

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Objective The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. Methods Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. Results The majority of the 130 enrolled patients > 55 years of age returned for pain (57%), were African American (78%), were younger (55–64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8–0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3–7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0–1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. Conclusions The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.

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Section: Age As a Predictor For Pain-related Returnscontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

et al. 2020

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“…These ED visits take longer, represent higher‐acuity illnesses, and require more intensive services, resulting in increased costs 1,3,4 . ED visits for older adults are frequently followed by adverse events such as functional and physical decline, delirium, and death, 5‐8 with risk increasing for those with advanced age, frailty, multiple chronic conditions, and other conditions prevalent among older adults (e.g., dementia) 3,7,9‐11 . Although the majority of older ED patients are discharged, they are more likely to revisit the ED than younger adults and be subsequently admitted to the hospital 3,10 .…”

Section: Introductionmentioning

confidence: 99%

“…ED visits for older adults are frequently followed by adverse events such as functional and physical decline, delirium, and death, 5‐8 with risk increasing for those with advanced age, frailty, multiple chronic conditions, and other conditions prevalent among older adults (e.g., dementia) 3,7,9‐11 . Although the majority of older ED patients are discharged, they are more likely to revisit the ED than younger adults and be subsequently admitted to the hospital 3,10 . Recent studies have shown that approximately 20% to 25% of older ED patients return within 30 days of discharge, often due to nonadherence with medications and treatment plans, not understanding discharge instructions, lack of disease knowledge, increases in symptoms, or lack of social support 6,10,12‐15 …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

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Background Improving care transitions following emergency department (ED) visits may reduce post‐ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital‐to‐home transitions; however, its effectiveness at improving post‐ED outcomes is unknown. We tested the effectiveness of the CTI with community‐dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self‐management behaviors during the 30 days following discharge. Methods We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention‐to‐treat and per‐protocol (PP) analyses. Results Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30‐day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in‐person follow‐up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). Conclusions The CTI did not reduce 30‐day ED revisits but did significantly increase key care transition behaviors (outpatient follow‐up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.

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“…There are more studies that describe the hospital care of immigrants residing in Spain [36][37][38] in a more extensive way, but these do not address the healthcare needs when the boats arrive. In the same way, other studies address these same issues related to hospital care or access to specific services offered by different health systems in the context of other countries, analyzing their barriers and difficulties [39][40][41][42]. These studies emphasize that the attention needed by these populations are not limited to those presented at the time of their arrival, but, sometimes, the approach to the problems that appear later are much more complex.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain

Ponce-Blandón

Mérida-Martín²,

Jiménez-Lasserrotte

et al. 2020

IJERPH

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Background: The aim of this study is to identify the sociodemographic characteristics and the most frequent diseases and nursing interventions carried out on migrants arriving by sea at southern Spain. Method: Cross-sectional, descriptive, and retrospective study based on the database of the Spanish Red Cross Intervention Activation System. All migrants who arrived on the coasts of a southern province during 2016 and were assisted by the Red Cross were included. Results: A total of 2027 people were registered, mostly males, aged between 18 and 40 years. Of these, 4.9% required healthcare, and 2.9% were referred to hospital. Highlighted diagnoses were headaches (15.6%), pregnancy (12.8%), and lower-limb wounds (6.4%), and outstanding nursing interventions were “care of wounds” (24.7%), “pain management” (21.9%), and “prenatal care” (15.2%). Statistically significant relationships were found between the diagnosed diseases and gender, geographic area of origin, and seasonal time of the year, as well as between nursing interventions performed and those three variables. Conclusions: Although in general, a good health condition was observed in most of the migrants treated, the most frequent health situations attended were related to dermatological, gynecological, and headache problems. The most performed nursing interventions were related to skin/wound care and promotion of physical comfort, requiring a low need for hospital transfers. Female gender, origin from sub-Saharan Africa and arrival in the summer period carry a greater risk of suffering health problems when migrants reach Spanish coasts.

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Risk Factors Associated with Emergency Department Recidivism in the Older Adult

Cited by 21 publications

References 37 publications

Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain

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