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Abstract

Background:Older adults (65 years and older) often present to the emergency department (ED) with an unclear need for hospitalization, leading to potentially harmful and costly care. This underscores the importance of measuring the trade-off between admission and discharge for these patients in terms of patient outcomes.

Objective:This study aimed to measure the relationship between disposition decisions and 3-day, 9-day, and 30-day revisits, readmission, and mortality, using causal inference methods that adjust for potential measured and unmeasured confounding.

Methods:A longitudinal observational study (n=3591) was conducted using electronic health records from a large tertiary teaching hospital with an ED between January 1, 2014 and September 27, 2018. The sample consisted of older adult patients with 1 of 6 presentations with significant variability in admission: falls, weakness, syncope, urinary tract infection, pneumonia, and cellulitis. The exposure under consideration was the ED disposition decision (admission to the hospital or discharge). Nine outcome variables were considered: ED revisits, hospital readmission, and mortality within 3, 9, and 30 days of being discharged from either the hospital for admitted patients or the ED for discharged patients.

Results:Admission was estimated to significantly decrease the risk of an ED revisit after discharge (30-day window: −6.4%, 95% CI −7.8 to −5.0), while significantly increasing the risk of hospital readmission (30-day window: 5.8%, 95% CI 5.0 to 6.5) and mortality (30-day window: 1.0%, 95% CI 0.4 to 1.6). Admission was found to be especially adverse for patients with weakness and pneumonia, and relatively less adverse for older adult patients with falls and syncope.

Conclusions:Admission may not be the safe option for older adults with gray area presentations, and while revisits and readmissions are commonly used to evaluate the quality of care in the ED, their divergence suggests that caution should be used when interpreting either in isolation.

Details

Title
Revisits, Readmission, and Mortality From Emergency Department Admissions for Older Adults With Vague Presentations: Longitudinal Observational Study
Author
Alvarez Avendano, Sebastian Alejandro  VIAFID ORCID Logo  ; Cochran, Amy  VIAFID ORCID Logo  ; Valerie Odeh Couvertier  VIAFID ORCID Logo  ; Patterson, Brian  VIAFID ORCID Logo  ; Shah, Manish  VIAFID ORCID Logo  ; Zayas-Caban, Gabriel  VIAFID ORCID Logo 
First page
e55929
Section
Health Services Research and Health Care Utilization in Older Patients
Publication year
2025
Publication date
2025
Publisher
JMIR Publications
e-ISSN
25617605
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3164305831