Cargando…
Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine
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 th...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Canadian Geriatrics Society
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815936/ https://www.ncbi.nlm.nih.gov/pubmed/27076860 http://dx.doi.org/10.5770/cgj.19.195 |
_version_ | 1782424645431984128 |
---|---|
author | Hominick, Kathryn McLeod, Victoria Rockwood, Kenneth |
author_facet | Hominick, Kathryn McLeod, Victoria Rockwood, Kenneth |
author_sort | Hominick, Kathryn |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4815936 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Canadian Geriatrics Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-48159362016-04-13 Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine Hominick, Kathryn McLeod, Victoria Rockwood, Kenneth Can Geriatr J Original Research 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. Canadian Geriatrics Society 2016-03-31 /pmc/articles/PMC4815936/ /pubmed/27076860 http://dx.doi.org/10.5770/cgj.19.195 Text en © 2016 Author(s). Published by the Canadian Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (http://creativecommons.org/licenses/by-nc-nd/2.5/ca/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited. |
spellingShingle | Original Research Hominick, Kathryn McLeod, Victoria Rockwood, Kenneth Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title | Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title_full | Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title_fullStr | Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title_full_unstemmed | Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title_short | Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine |
title_sort | characteristics of older adults admitted to hospital versus those discharged home, in emergency department patients referred to internal medicine |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815936/ https://www.ncbi.nlm.nih.gov/pubmed/27076860 http://dx.doi.org/10.5770/cgj.19.195 |
work_keys_str_mv | AT hominickkathryn characteristicsofolderadultsadmittedtohospitalversusthosedischargedhomeinemergencydepartmentpatientsreferredtointernalmedicine AT mcleodvictoria characteristicsofolderadultsadmittedtohospitalversusthosedischargedhomeinemergencydepartmentpatientsreferredtointernalmedicine AT rockwoodkenneth characteristicsofolderadultsadmittedtohospitalversusthosedischargedhomeinemergencydepartmentpatientsreferredtointernalmedicine |