Pre-hospital Conditions Affecting the Hospitalization Risk in Older Adults at the Emergency Department

Abstract

Introduction: The Emergency Department (ED) is a common route to hospitalization for critically ill and older adults. Older patients are admitted to hospital at a higher rate and have longer length of stay (LOS) when hospitalized. To be able to confront an increasing aging population, meet their medical needs and influence rising costs of health care, there is a need to focus on the older population. In Scandinavia, few studies are made that focus on the geriatric population at the ED. It is essential to early identify risk factors for hospitalization at the ED to improve the medical care for older adults and the influence of prehospital comorbidities. Methods: This is a retrospective observational study of older adults visiting the ED in southwest Sweden. The aim of this study was to examine if routinely collected patient demographics and prehospital comorbidities were associated with ED disposition and in-patient process outcomes. The data collection was generated from the Regional Healthcare Information Platform. The variables extracted were age, gender, ED-visits, LOS at ED, admission rate, in-hospital LOS and comorbidities before visiting the ED. Results: A total of 15 528 patients aged ≥ 65 years visited the ED during 2016, 8 098 (52%) were female and 7 430 (48%) were male, 6 631 (41%) were 65–74 years of age, 5 585 (36%) were 75–84 years of age and 3 612 (23%) were 85 years or older. LOS at the ED were over 4 hours for 45% of the population. Patients aged 85 or older had a Hazard ratio of 2.56 (CI 2.33–2.82) for admission and patients with HF had a Hazard ratio of 1.75 (CI 1.46–2.09). Conclusion: Patients with old age, HF and comorbidities as prehospital conditions have a significant higher risk for admission to the hospital and a longer in-hospital stay regardless reason for the ED visit. The awareness of this could help physicians identify older patients with high risk for admission and early initiate an admission plan to be able to reduce LOS at the ED.