Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Sep;56(9):1651-7.
doi: 10.1111/j.1532-5415.2008.01840.x. Epub 2008 Aug 4.

Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged From the Emergency Department

Affiliations
Free PMC article

Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged From the Emergency Department

S Nicole Hastings et al. J Am Geriatr Soc. .
Free PMC article

Abstract

Objectives: To determine whether frail older adults, based on a deficit accumulation index (DAI), are at greater risk of adverse outcomes after discharge from the emergency department (ED).

Design and setting: Secondary analysis of data from the Medicare Current Beneficiary Survey.

Participants: One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees, aged 65 and older who were discharged from the ED between January 2000 and September 2002.

Measurements: The primary dependent variable was time to first adverse outcome, defined as repeat outpatient ED visit, hospital admission, nursing home admission, or death, within 30 days of the index ED visit.

Results: Time to first adverse outcome was shortest in individuals with the highest number of accumulated deficits. The frailest participants were at greater risk of adverse outcomes after ED discharge than those who were least frail (hazard ratio (HR)=1.44, 95% confidence interval (CI)=1.06-1.96). The frailest individuals were also at higher risk of serious adverse outcomes, defined as hospitalization, nursing home admission, or death (HR=1.98, 95% CI=1.29-3.05). In contrast, no association was detected between degree of frailty and repeat outpatient ED visits within 30 days (HR=1.06, 95% CI=0.73-1.54).

Conclusion: The DAI as a construct of frailty was a robust predictor of serious adverse outcomes in the first 30 days after ED discharge. Frailty was not found to be a major determinant of repeat outpatient ED visits; therefore, additional study is needed to investigate this particular type of health service use by older adults.

Figures

Figure 1
Figure 1
Survival curve for first adverse outcome (outpatient ED visit, hospitalization, nursing home admission or death) according to level of frailty, adjusted for demographics, living situation, insurance status and previous health service use (P=0.0036 for overall difference between groups).
Figure 2
Figure 2
Figure 2a. Survival curve for repeat outpatient ED visit according to level of frailty, adjusted for demographics, living situation, insurance status and previous health service use (P=0.51 for overall difference between groups). Figure 2b. Survival curve for hospitalization, nursing home admission or death according to level of frailty, adjusted for demographics, living situation, insurance status and previous health service use (P=0.0002 for overall difference between groups).
Figure 2
Figure 2
Figure 2a. Survival curve for repeat outpatient ED visit according to level of frailty, adjusted for demographics, living situation, insurance status and previous health service use (P=0.51 for overall difference between groups). Figure 2b. Survival curve for hospitalization, nursing home admission or death according to level of frailty, adjusted for demographics, living situation, insurance status and previous health service use (P=0.0002 for overall difference between groups).

Similar articles

See all similar articles

Cited by 41 articles

See all "Cited by" articles

Publication types

MeSH terms

Feedback