Risk of admission within 4 weeks of discharge of elderly patients from the emergency department—the DEED study

Abstract

Objective: to identify risk factors for admission for patients aged 75 years and older after discharge from the emergency department (DEED: discharge of elderly from emergency department). Design: prospective evaluation of discharged elderly patients from the emergency department who were followed up after 4 weeks. Setting: emergency department of a teaching hospital for 1 year. Subjects: patients aged 75 and over discharged to their home or hostel. Main outcome measures: demographic data, indices of function and cognitive status and admission to hospital within 4 weeks. Results: 468 patients aged 75 and over (mean age 81.7 years; range 75 – 98) were enrolled; 80 patients (17.1%) were admitted to hospital during the subsequent 4 weeks. Risk factors for admission included dependence in the following activities of daily living (relative risk; 95% confidence interval): bathing (2.41; 1.32–4.41); dressing (2.38; 1.22–4.63); stairs (1.60; 1.09–2.33); finance (1.66; 1.23–2.25); shopping (1.39; 1.12–1.73) and transport (1.61; 1.25–2.06), as well as use of a community nurse (1.88; 1.12–3.17). Logistic regression analysis found two variablesto be significant in predicting admission or not: dependence in transport and use of a community nurse. Conclusions: older patients are at increased risk of readmission within 4 weeks of being sent home from the emergency department. It is possible to identify high-risk patients by a questionnaire. This allows targeting of these patients for more intensive follow-up in an attempt to ameliorate further deteriorations in their health.