Key points Are patient-related factors that disproportionately affect older adults, including lower functional status, cognitive decline, limited social support, and geriatric syndromes, associated with emergency department (ED) physicians’ decision to admit patients ? at the hospital? Findings In this cohort study of 42,392 ED visits from 11,783 unique patients, functional status, cognitive status, and social support were associated with the likelihood of admission from the ED, while no association was found with other syndromes. common nursing homes. Meaning The findings of this study suggest that incorporating patient-level factors is essential to understanding the factors associated with hospital admission of older ED patients and potential areas for designing interventions to reduce treatable low-value admissions. in other environments. |
Importance
The role of patient-level factors unrelated to the specific clinical condition leading to an emergency department (ED) visit, such as functional status, cognitive status, social support, and geriatric syndromes, in Admission decisions are not well understood, in part because these data are not available in administrative databases.
Aim
To determine the extent to which patient-level factors are associated with rates of hospital admission from the emergency department.
Design, environment and participants
This cohort study analyzed survey data collected from participants (or their representatives, such as family members) enrolled in the Health and Retirement Study (HRS) from January 1, 2000 to December 31, 2018. These HRS data were linked to Medicare fee-for-service claims data from January 1, 1999 to December 31, 2018.
Information on functional status, cognitive status, social support, and geriatric syndromes was obtained from HRS data, while emergency department visits, hospital post-ED admission or discharge, and other comorbidities arising from claims and sociodemographic characteristics were obtained from Medicare data. The data was analyzed from September 2021 to April 2023.
Main results and measures
The primary outcome measure was hospital admission after an emergency department visit. A baseline logistic regression model was estimated, with a binary indicator of income as the dependent variable of interest.
For each primary variable of interest derived from the HRS data, the model was re-estimated, including the HRS variable of interest as an independent variable. For each of these models, the odds ratio (OR) and the average marginal effect (AME) of changing the value of the variable of interest were calculated.
Results
A total of 42,392 emergency department visits from 11,783 unique patients were included. At the time of the ED visit, patients had a mean (SD) age of 77.4 (9.6) years, and visits were predominantly female (25,719 visits [60.7%]) and white race (32,148 visits [75.8%]).
The overall percentage of patients admitted was 42.5%. After controlling for ED diagnosis and demographic characteristics, functional status, cognitive status, and social support were associated with the probability of admission.
For example, difficulty performing 5 activities of daily living was associated with an 8.5 percentage point increase (OR, 1.47; 95% CI, 1.29-1.66) in the likelihood of admission.
Having dementia was associated with an increase in SMA probability of admission of 4.6 percentage points (OR, 1.23; 95% CI, 1.14-1.33).
Living with a spouse was associated with a 3.9 percentage point decrease in SMA admission odds (OR, 0.84; 95% CI, 0.79-0.89), and having children living in a 10-mile radius was associated with a 5.0 percentage point decrease in SMA admission probability (OR, 0.80; 95% CI, 0.71-0.89).
Other common geriatric syndromes, including difficulty falling asleep, early awakening, vision problems, glaucoma or cataracts, hearing aid use or hearing problems, falls in the past 2 years, incontinence, depression, and polypharmacy, were not significantly associated with the probability of admission 95% CI, 0.71-0.89).
Conclusion and relevance The results of this cohort study suggest that key patient-level characteristics, including social support, cognitive status, and functional status , were associated with the decision to admit older patients to the hospital from the ED. It is critical to consider these factors when designing strategies to reduce low-value admissions among older ED patients. |
