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Sociodemographic characteristics, comorbidity, and baseline functional status of older patients treated in emergency departments during the COVID-19 pandemic and associations with mortality: an analysis based on the EDENCOVID cohort

Gonz√°lez Del Castillo J, Jacob J, Garc√≠a-Lamberechts EJ, Pi√Īera Salmer√≥n P, Alqu√©zar-Arb√© A, Llorens P, Jim√©nez S, Quero Espinosa FB, Aguil√≥ S, Gil-Rodrigo A, Fern√°ndez Alonso C, Burillo-Putze G, Espinosa Fern√°ndez B, Suero M√©ndez C, Iglesias Vela M, Quero Motto E, Hong Cho JU, Llopis F, Marr√≥n Tundidor R, Gayoso Mart√≠n S, Lucena Aguilera C, Alemany Gonz√°lez X, Rizzi MA, Llauger L, Murcia Olag√ľenaga A, Vaswani-Bulchand A, Parra Esquivel P, S√°nchez Nicol√°s JA, Carrasco Fern√°ndez E, Ruescas Escolano E, Chac√≥n Garc√≠a A, Fern√°ndez Salgado F, Mir√≥ O

Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain. Emergency Department, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain. Emergency Department, Hospital Reina Sofía, Murcia, Spain. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain. Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. Emergency Department, Hospital Universitario Reina Sofía, Córdoba, Spain. Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain. Hospital de la Axarquía, Málaga, Spain. Complejo Asistencial Universitario de León, León, Spain. Hospital Clínico Universitario Virgen Arrixaca, Murcia, Spain. Hospital De Mendaro, Guipuzkoa, Spain. Hospital De Bellvitge, L’hospitalet de Llobregat, Barcelona, Spain. Hospital Universitario Miguel Servet. Zaragoza, Spain. Hospital Comarcal de El Escorial, Madrid, Spain. Hospital Universitari de Vic, Barcelona, Spain. Hospital del Nalón, Asturias, Spain. Hospital del Norte de Tenerife, Tenerife, Spain. Hospital Altagracia, Manzanares, Ciudad Real, Spain. Hospital Universitario Vinalopó, Elche, Alicante, Spain. Servicio de Admisión y Documentación Clínica, Hospital Clínico San Carlos, Madrid, Spain. Hospital Universitario de Móstoles, Madrid, Spain.

Objective. To describe the sociodemographic characteristics, comorbidity, and baseline functional status of patients aged 65 or older who came to hospital emergency departments (EDs) during the first wave of the COVID-19 pandemic, and to compare them with the findings for an earlier period to analyze factors of the index episode that
were related to mortality.
Methods. We studied data from the EDEN-COVID cohort (Emergency Department and Elder Needs During COVID-19) of patients aged 65 years or older treated in 40 Spanish EDs on 7 consecutive days. Nine sociodemographic variables, 18 comorbidities, and 7 function variables were registered and compared with the findings for the EDEN cohort of patients included with the same criteria and treated a year earlier in the same EDs .
In-hospital mortality was calculated in the 2 cohorts and a multivariable logistic regression model was used to explore associated factors.
Results. The EDEN-COVID cohort included 6806 patients with a median age of 78 years; 49% were women. The pandemic cohort had a higher proportion of men, patients covered by the national health care system, patients brought from residential facilities, and patients who arrived in an ambulance equipped for advanced life support. Pandemic-cohort patients more often had diabetes mellitus, chronic kidney disease, and dementia; they less
often had connective tissue and thromboembolic diseases. The Barthel and Charlson indices were worse in this period, and cognitive decline was more common. Fewer patients had a history of depression or falls. Eight hundred ninety these patients (13.1%) died, 122 of them in the ED (1.8%); these percentages were lower in the
earlier EDEN cohort, at 3.1% and 0.5%, respectively. Independent sociodemographic factors associated with higher mortality were transport by ambulance, older age, male sex, and living in a residential facility. Mortalityassociated comorbidities were neoplasms, chronic kidney disease, and heart failure. The only function variable
associated with mortality was the inability to walk independently. A history of falls in the past 6 months was a protective factor.
Conclusions. The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.

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