Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine

被引:16
作者
Hominick, Kathryn [1 ,2 ]
McLeod, Victoria [1 ]
Rockwood, Kenneth [1 ,3 ]
机构
[1] Geriatr Med Res Unit, Halifax, NS, Canada
[2] Capital Dist Hlth Author, Halifax, NS, Canada
[3] Dalhousie Univ, Div Geriatr Med, Halifax, NS, Canada
来源
CANADIAN GERIATRICS JOURNAL | 2016年 / 19卷 / 01期
关键词
frail older adults; frailty index; geriatric assessment; social factors; social work; aged; emergency department; hospital admission; hospital discharge; delirium; mobility impairment;
D O I
10.5770/cgj.19.195
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background Frail older adults present to the Emergency Department (ED) with complex medical, functional, and social needs. When these needs can be addressed promptly, discharge is possible, and when they cannot, hospital admission is required. We evaluated the care needs of frail older adults in the ED who were consulted to internal medicine and seen by a geriatrician to determine, under current practices, which factors were associated with hospitalization and which allowed discharge. Methods We preformed a chart-based, exploratory study. Data were abstracted from consultation records and ED charts. All cases had a standard Comprehensive Geriatric Assessment (CGA which records a Clinical Frailty Scale (CFA) and allows calculation of a Frailty Index (FI). Results Of 100 consecutive patients, 2 died in the ED, 75 were admitted, and 23 were discharged, including one urgent placement. Compared with discharged patients (0.39 +/- SD 0.16), those admitted had a higher mean FI-CGA (0.48 +/- 0.13; p < .01). Greater mobility dependence (2% in discharged vs. 32% in admitted; p < .05) was notable. Conclusions Discharge decisions require assessment of medical, functional, and social problems. Ill, frail patients often can be discharged home when social and nursing support can be provided. The degree of frailty, impaired mobility, and likely delirium must be taken into account when planning for their care.
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页码:9 / 14
页数:6
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