Self‐rated health in the unwell elderly presenting to the emergency department
- 8 February 2007
- journal article
- Published by Wiley in Emergency Medicine Australasia
- Vol. 19 (3), 196-202
- https://doi.org/10.1111/j.1742-6723.2007.00924.x
Abstract
Self-rated health (SRH) has been shown to be a reliable predictor of functional decline and mortality. These studies, however, have largely focused on well community-dwelling elderly. We assessed whether the predictive value of SRH would still be valid for the acutely unwell older person presenting to the ED. The present study was a secondary analysis of data obtained from the Discharge of Elderly from Emergency Department (DEED II) study. The sample consisted of 741 older people sent home from an ED. On enrollment, patients were asked the SRH question, 'In general, would you say your health is excellent, very good, good, fair or poor?' Phone interviews were conducted at 3, 6, 12 and 18 months. Functional status was assessed using the Barthel index of activities of daily living (ADL), modified instrumental activities of daily living (IADL) and the Short Portable Mental Status Questionnaire (MSQ). An SRH of fair/poor produced a hazard ratio of 3.1 (95% confidence interval 1.3-7.2, P = 0.010) for predicting mortality after controlling for confounders. The rate of decline in ADL and IADL (but not MSQ) over time was also more pronounced for those with an SRH of fair/poor (P < 0.001 for both ADL and IADL). An SRH of fair/poor had a relative risk of 3.4 for predicting decline in ADL at 18 months (95% confidence interval 1.7-7.1, P = 0.001). The effects of SRH on IADL and MSQ were not statistically significant. The ability of SRH to predict functional decline and mortality persists for the acutely unwell elderly presenting to the ED. SRH is a simple and valuable tool to assess the elderly in the ED and to identify high-risk patients who would benefit from comprehensive geriatric assessment aimed at delaying such outcomes.Keywords
This publication has 25 references indexed in Scilit:
- Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care InstrumentJournal of the American Geriatrics Society, 2008
- Does Self‐Rated Health Predict Survival in Older Persons with Cognitive Impairment?Journal of the American Geriatrics Society, 2004
- The role of clinical risk factors in understanding self-rated healthAnnals of Epidemiology, 2004
- The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adultsJournal of Epidemiology and Community Health, 2000
- Community Studies Reporting Association between Self-Rated Health and MortalityResearch on Aging, 1999
- Self-Rated Health and Mortality Over Three DecadesResearch on Aging, 1999
- Risk of admission within 4 weeks of discharge of elderly patients from the emergency department—the DEED studyAge and Ageing, 1998
- The MOS 36-ltem Short-Form Health Survey (SF-36)Medical Care, 1992
- Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study.American Journal of Public Health, 1990
- Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily LivingThe Gerontologist, 1969