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Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

  • Jonathan Afilalo (a1), Salvatore Mottillo (a2), Xiaoqing Xue (a3), Antoinette Colacone (a3), José A. Morais (a4), J. Scott Delaney (a5) and Marc Afilalo (a3)...

Abstract

Background

A growing number of frail older adults are treated in the emergency department (ED) and discharged home. There is an unmet need to identify older adults that are predisposed to functional decline and repeat ED visits so as to target them with proactive interventions.

Methods

A prospective cohort study was conducted in patients 75 years or older who were being discharged from the ED. The objective was to test the value of frailty screening tests, namely 5-meter gait speed and handgrip strength, to predict repeat ED visits at 1 and 6 months and functional decline at 1 month using multivariable logistic regression.

Results

After excluding 7 patients lost to follow-up, 150 patients were available for analysis. The mean age was 81.1 ± 4.9 years with 51% females, 13% arriving by ambulance, and 67% having at least two comorbid conditions. At ED discharge, 41% of patients were found to have slow gait speed, whereas 23% had weak handgrip strength. After adjustment, only slow gait speed was independently associated with functional decline at 1 month (odds ratio [OR] 1.39 per 0.1 meters/second decrement, 95% confidence interval [CI], 1.12 to 1.72) and repeat ED visits at 6 months (OR 1.20 per 0.1 meters/second decrement, 95% CI, 1.01 to 1.42).

Conclusions

Gait speed can be feasibly measured at the time of ED discharge to identify frail older adults at risk for early functional decline and subsequent return to the ED. Conversely, grip strength was not found to be associated with functional decline or ED visits.

RésuméContexte

Un nombre croissant de personnes âgées fragiles obtiennent leur congé et retournent à domicile après avoir été traitées au service des urgences (SU). Toutefois, il faudrait trouver un moyen de reconnaître les personnes âgées prédisposées à une perte d'autonomie et à des consultations à répétition au SU afin de les cibler et d'intervenir de manière proactive.

Méthode

Il s'agit d'une étude de cohortes prospective, menée chez des personnes âgées de 75 ans et plus ayant obtenu leur congé du SU. L'objectif était d’évaluer la qualité des tests de dépistage de la fragilité, soit la vitesse de déambulation sur 5 mètres et la force de préhension, comme facteurs prévisionnels de consultations à répétition au SU au bout de 1 mois et de 6 mois, et de la perte d'autonomie au bout de 1 mois, à l'aide d'une analyse de régression logistique plurifactorielle.

Résultats

Après l'exclusion de 7 malades perdus de vue en cours de suivi, il restait en tout 150 patients qui ont participé à l’étude. L’âge moyen s’élevait à 81,1 ± 4,9 ans; les sujets se caractérisaient comme suit : 51% étaient des femmes; 13% sont arrivés en ambulance et 67% étaient atteints d'au moins deux affections concomitantes. Au moment du congé du SU, 41% des sujets avaient une vitesse de déambulation lente et 23%, une force de préhension faible. Après rajustement de certaines variables, seule la vitesse de déambulation s'est révélée un facteur indépendant associé à la perte d'autonomie au bout de 1 mois (risque relatif approché [RRA] : 1,39 par tranche de 0,1 mètre/seconde; IC à 95% : 1,12 à 1,72) et aux consultations à répétition au SU au bout de 6 mois (RRA : 1,20 par tranche de 0,1 mètre/seconde; IC à 95% : 1,01 à 1,42).

Conclusions

Le test de la vitesse de déambulation peut s'effectuer facilement avant le congé du SU afin de bien reconnaître les personnes âgées fragiles sujettes à une perte d'autonomie précoce et à des consultations ultérieures au SU. À l'inverse, la force de préhension n’était pas associée à la perte d'autonomie ou à des consultations à répétition au SU.

Copyright

Corresponding author

Correspondence to: Dr. Jonathan Afilalo, Director, Geriatric Cardiology Fellowship Program, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, E-222, Montreal, QC; Email: jonathan.afilalo@mcgill.ca

References

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Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

  • Jonathan Afilalo (a1), Salvatore Mottillo (a2), Xiaoqing Xue (a3), Antoinette Colacone (a3), José A. Morais (a4), J. Scott Delaney (a5) and Marc Afilalo (a3)...

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