NEW HAVEN, CT – One of the most difficult dilemmas facing emergency physicians is whether to admit elderly patients who are on the borderline of requiring hospitalization.

At least one factor in the decision has been data indicating that hospitalization hastens disability and decline. A new study published in Annals of Emergency Medicine might change the equation, however.

It also might push emergency departments (EDs) to focus more on assessments of function, which could be conducted by care transition coordinators or geriatric specialists, suggest the Yale University researchers.

Their study found that older adults who go to the ED for an illness or injury are at increased risk for disability and decline in physical abilities up to six months later.

Background information in the article notes that most patients 65 years and older who visit the ED are treated and sent home. It also points out that, while previous research shows that older adults are more likely to experience disability and declines in function after a hospitalization, little information has been available about what happens after a visit to and discharge from the ED.

Prospective data collected on more than 700 older adults over 14 years was used for the study, which employed a scoring system to assess the presence and severity of disability among:

• adults who had visited the ED and been discharged;
• those who had been hospitalized after an ED visit; or
• a control group consisting of adults who had not come to the ED at all.

Nursing home admissions and mortality also were assessed after an ED visit.

While participants who had been hospitalized had the highest disability scores, results indicate that the discharged group also had significantly higher disability scores than the control group. Those patients were also more likely to be living in a nursing home, and/or to die, in the six-month period after going to the ED.

“We know that if older persons go to the hospital and are admitted, they are at increased risk of disability and functional decline. This study shows that patients discharged from the ED, meaning that they were deemed well enough to return home, are also at risk for functional decline,” said first author Justine M. Nagurney, MD, a resident in Emergency Medicine at Yale New Haven Hospital. “We should be doing something to address that.”

“Patients may benefit from ED-based initiatives to evaluate and potentially intervene upon changes in disability status,” Nagurney suggested.