Elderly face increased disability risk after emergency room visit

Old people in geriatric hospice: Aged patient receives the visit of a female black doctor. They shake their hands and talk in the hospital. (iStock)

Elderly patients who get treated for illnesses or injuries in the emergency department (ED) are at risk of increased disability for up to six months afterward, a recent study suggests.

To look at how ED visits might relate to functioning once patients go home, researchers examined data on 754 elderly patients who went to the ED without being admitted to the hospital and another 813 similar people who didn't visit the ED.

At the start of the study, they had comparable functional abilities, with both groups scoring fairly low on a disability scale. But those who had an ED visit scored an average of 14 percent higher on the same scale over the next six months, researchers report in the Annals of Emergency Medicine.

"The higher risk of disability following emergency department visits is likely related to the illness or injury that led these patients to seek care in the emergency department," said study co-author Dr. William Fleischman, an emergency medicine researcher at the University of Maryland in Baltimore.

"This does not mean that these patients should have avoided the emergency department or that they should have been hospitalized," Fleischman, who completed the study as a researcher at Yale University, added by email. "Rather, it suggests that older adults who are medically appropriate for discharge from the emergency department may benefit from the kind of discharge planning that often occurs in the inpatient setting."

For the 14-year study, participants completed home-based assessments every 18 months and were also interviewed monthly to reassess their functional status, identify any illnesses or injuries leading to ED visits or hospitalizations and identity nursing home admissions and deaths.

Participants were about 84 years old on average when they joined the study, and they were all living in the community, not in institutional settings like nursing homes or assisted living facilities.

Disability was measured on a scale of zero to 13, with higher scores indicating poorer functioning on basic tasks of daily living like dressing and walking, as well as more complex tasks like meal preparation, driving and managing finances.

In addition to rising disability scores, researchers found that people who had ED visits were more than three times as likely as those who didn't to be admitted to nursing homes within the next six months, and they were almost twice as likely to die.

People who were admitted to the hospital after an ED visit tended to fare even worse.

Hospitalized patients' average disability scores were 17 percent higher than scores of patients seen in the ED and sent home, the study found. These hospitalized patients also had the highest risk of nursing home admissions and death.

One limitation of the study is that it only included patients insured by one health plan in a small urban area, which may limit how similar the findings would be for people in other parts of the U.S. or with other types of medical coverage, the authors point out.

The study wasn't a controlled experiment designed to prove whether ED visits or hospital admissions directly cause a decline in functioning for elderly people, or why, the authors also note.

Still the results should be a red flag to watch elderly patients closely when they're sent home from the ED or the hospital, said Dr. Amy Kelley, a geriatrics researcher at Icahn School of Medicine at Mount Sinai in New York.

"Older adults and their families can do their best to manage chronic health conditions in partnership with their doctors and ask for additional services such as home care or palliative care for symptom management in an attempt to avoid the need for ED visits when possible," Kelley, who wasn't involved in the study, said by email.

"After an ED visit, they can work with their healthcare providers to optimize physical function, add needed support at home and continuing discussions to ensure that the individual's personal priorities are always the true focus of the healthcare plan," Kelley added.