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Factors associated with short-term mortality after emergency department care of residents living in aged care homes: findings from the multicenter Caregency study




Afonso-Argilés FJ, Comas Serrano M, Blázquez Andión M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, Gómez Roldán JM, Pujadas Lafarga T, Ichart Tomás X, Puig Campmany M, Rizzi MA, Sinfreu Pujol A, Tejero Cano I, Vena Martínez AB, Villanueva Sánchez H, Renom-Guiteras A



Servicio de Geriatría, Fundació Sanitària Mollet, Barcelona, Spain. Estudiante de doctorado de la Universitat Autònoma de Barcelona, Barcelona, Spain. Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain. Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain. Miembro de la Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Servicio de Urgencias, Hospital Universitari Parc de Salut Mar, Barcelona, Spain. Servicio de Urgencias, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, Spain. Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Barcelona, Spain. Servicio de Urgencias, Hospital Universitari Arnau de Vilanova, Lleida, Spain. Servicio de Geriatría, Hospital Universitario Parc de Salut Mar, Barcelona, Spain. Servicio de Geriatría, Hospital Universitari Arnau de Vilanova, Lleida, Spain..



Objectives. To evaluate short-term mortality in people transferred from aged care homes for treatment in a hospital emergency department (ED) and to analyze factors associated with mortality.
Methods. Multicenter study of a random sample of retrospective data of patients treated in 5 EDs in Catalonia in 2017. The patients were over the age of 65 years and lived in residential care facilities. In addition to short-term mortality (in the ED or within 30 days of discharge), we analyzed sociodemographic characteristics, prior functional and cognitive status, multimorbidity, triage level on arrival, length of stay in the ED, and hospital admission. Odds ratios (ORs) for factors associated with short-term mortality were calculated by multivariate regression analysis.
Results. A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.1) years, and 67.7% were women. Short-term mortality (in 15.5%) was associated with age >90 years (OR, 1.50; 95% CI, 1.5-1.95 years), a Charlson index >2 (OR, 1.47; 95% CI, 1.14-1.90), and dependency assessed as moderate (OR, 1.50; 95% CI, 1.03-
2.20) or severe (OR, 2.56; 95% CI, 1.84-3.55). Other associated factors were a higher level of urgency on triage, duration of ED stay, and hospital admission.
Conclusions. Aged residents with the characteristics associated with short-term mortality could benefit from interventions for potentially avoiding unnecessary transfers to an ED, and from the implementation of comprehensive geriatric care within the ED. This could be useful to support good quality of care at the end of life.


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