Autor:innen:
D. Rudol (Koblenz, DE)
M. Rarek (Köln, DE)
A. Meyer (Köln, DE)
L. Pickert (Köln, DE)
I. Becker (Köln, DE)
M. Polidori (Köln, DE)
Background and Aim
Older patients admitted to the Emergency Department (ED) display often complex syndromes and reasons for admission that remain uncovered in usual care but strongly influence health trajectories. Comprehensive Geriatric Assessment (CGA)-based tools are currently under the spotlight for more effective clinical decision making and risk stratification in urgent settings.
Methods
Multimorbid patients aged 75 years and older underwent, in two ED recruitment waves, usual care plus frailty and prognosis evaluation by means of the CGA-based Multidimensional Prognostic Index (MPI) as well as measurement of health-related quality of life as assessed by the EQ5D (EuroQualityofLife-5 Dimension). Patients were contacted every 6 months up to two years after ED visit to collect information on survival, rehospitalizations, admission to long-term care facilities as well as on quality of life.
Results
Overall 166 (74f, 92m) participants could be recruited for this study, the average age was 81,1 (±4,5). After undergoing a CGA based assessment the participants were divided into MPI groups 1 (low risk, robust, 57,8%), 2 (moderate risk, prefrail, 36,1%) and 3 (high risk, frail, 6,0%). A preliminary evaluation indicates that 29,5% of the patients (n=49) are deceased at 6 months, 34,9% (n=58) at 12, 38,0% (n=63) at 18 and 44,6% (n=74) at 24 months, with 32 patients (19,3%) lost to follow-up (n=9 declining further follow-up and n=23 untraceable). Main reasons for ED admission were cardiac (33,1%), respiratory tract (13,3%), or neurological (10,2%) diseases. The preliminary results show a positive correlation, by use of the Spearman-Roh correlation coefficient, between the MPI index and the length of hospital stay (0,176; p < 0,05). In addition, number of rehospitalization days and the MPI index tend to be significantly correlated; after 12 (0,175; p = 0,105) and 24 months (0,122; p = 0,306).
Conclusions
Due to the small number of subjects and only beginning analysis, preliminary results of the study are limited. Nevertheless, it can be stated that a large proportion of elderly multimorbid patients admitted to the emergency department have died two years after hospitalization. The use of feasible CGA-based tools capable of capturing geriatric syndromes, functional decline, and psychosocial deficits beyond DRG coding can be usefull to improve clinical decision-making and overall health outcomes.