Emergency Department Geriatric Assessment and Short-Term Mortality in Hospitalized Elderly Medical Patients

摘要

Background: We studied which elements of an emergency department geriatric assessment (EDGA) are associated with a short-term mortality in hospitalized elderly medical patients. Methods: This was a retrospective cohort study. Medical charts of all consecutive elderly (aged >= 75 years) patients who had undergone an EDGA and had been admitted to internal medicine departments of a tertiary medical center between April 2010 and June 2011 were reviewed. The study group included patients who died within 3 months, and the control group included patients who survived during this time. A regression analysis was used to study which of the following elements of an EDGA were independently associated with a 3-month mortality: caregiver support, independence in activities of daily living, immobility, incontinence, cognitive decline, recurrent falls, and the number of medications. Results: The final cohort included 368 patients: 236 (64.1%) women; the mean age was 84.3 +/- 5.3 years. Overall, 61 (16.6%) patients died within 3 months. Dead patients were significantly more dependent, more immobile, and more incontinent compared with those who survived (p < 0.0001 for all). A regression analysis showed that only immobility was independently associated with a 3-month mortality (odds ratio 1.9; p = 0.001). A 3-month cumulative survival was significantly higher in ambulant patients relative to cane/walker users, in cane/walker users relative to patients who needed assistance, and in patients who needed assistance relative to totally immobile patients (p < 0.0001). Conclusion: Immobility documented during an EDGA at the time of admission is associated with 3-month mortality in hospitalized elderly medical patients.