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Be Skeptical of Elderly Patients Who Claim Adequate Mobility at Discharge

CHAPEL HILL, NC – If elderly patients assure you that they can get along fine at home, don’t be too quick to believe them.

A study published online recently inAnnals of Emergency Medicine suggests that many older patients visiting EDs require more assistance with physical tasks than they let on. Failing to take that into consideration could lead to a future hospital admission, according to the study team led by University of North Carolina Chapel Hill researchers.

“Ensuring that older adults discharged from the emergency department are able to safely function in their home environment is important because those who are unable to function safely at home are at risk for falls and return ER visits," said lead study author Timothy Platts-Mills, MD, MSc. "Accurately determining the ability of these patients to care for themselves at home is critical for emergency physicians as they make decisions about whether to discharge patients home or elsewhere. A patient who reports they can walk with an assistive device but actually requires human assistance to walk is likely to be bed-bound or to fall if they go home alone."

The cross-sectional study of cognitively intact patients aged 65 years and older, who were neither nursing home residents nor critically ill, was conducted in two academic EDs. Researchers asked consenting participants whether they could get out of bed, walk 10 feet, turn around, and get back in bed without assistance, and, if not, whether they could perform this task with a cane, walker, or assistance. Each participant was then asked to perform the task and was provided with a mobility device or assistance as requested.

Results indicate that, overall, 77% of patients in the study accurately assessed their ability to perform tasks. Of patients who said they could perform the assigned tasks without assistance, 12% required some assistance or were unwilling to complete the tasks. Among patients who said they could perform the task with a cane or walker, 48% required either human assistance or were unable to perform the task. Finally, nearly a fourth, 24%, of those who said they could perform the task with human assistance were unable to perform the task even with someone helping them.

"Emergency physicians are experts in deciding who can go home and who needs to come in the hospital," Platts-Mills said in an American College of Emergency Physicians press release. "But we are not perfect and sometimes we make decisions based on patient statements about abilities, rather than direct assessments.

“Our results suggest that patient statements are sometimes inaccurate, and, particularly for older adults who need some assistance, directly observing the patient's ambulation can be informative. Of course being able to move around isn't the only determinant of whether an older adult can be safely sent home, but it is a critical piece of information and it's good to get it right."