How different are older people discharged from emergency departments compared with those admitted to hospital?

OBJECTIVE

To compare the characteristics of older people presenting to the emergency department (ED) and admitted to hospital with those discharged directly from the ED and identify factors independently associated with hospital admission.

DESIGN

This is a cross-sectional survey of 306 community dwelling people aged 65 years or older presenting to two hospital EDs. A structured questionnaire and ED records were used to collect patient demographics, socioeconomic, physical, cognitive and social network information.

STATISTICS

The profile of admitted and discharged patients was compared using the χ statistic. Logistic regression was used to identify factors independently associated with hospital admission. Odds ratios (OR) and 95% confidence intervals (CI) are presented.

RESULTS

The analysis involved 306 patients, 158 admitted and 148 discharged home. There was no significant difference in demographic, socioeconomic, cognitive and social networks between the groups. Factors independently associated with hospital admission in the multivariate model were as follows: prior hospital admission OR 6.16 (95% CI 2.61, 14.50), Manchester Triage category 1-2 OR 5.01 (95% CI 1.19, 21.10), low-energy levels OR 3.97 (95% CI 1.32, 11.9) and presenting with cardiac OR 3.59 (95% CI 1.05, 12.3), neurological OR 4.47 (95% CI 1.21, 16.5) or respiratory-related conditions OR 11.2 (95% CI 2.41, 51.9). Among the cohort of discharged patients, 20-30% shared similar physical and mental health characteristics to admitted patients.

CONCLUSION

In this elderly population, health-related variables were the only independent factors associated with hospital admission. Approximately 30% of patients discharged home from ED had similar risk profiles to admitted patients.