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A BSTRACTS
D32
Comparison of Three Screening Tools to Predict Hospital
Readmission and Mortality in Older Adults.
M. Deschodt, 1,2 J. Flamaing, 2 N. Wellens, 1 S. Boonen, 2 P. Moons, 1
K. Milisen. 1,2 1. Center for Health Services and Nursing Research,
Katholieke Universiteit Leuven, Leuven, Belgium; 2. Department of
Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Purpose: To compare the diagnostic characteristics of the Identification
of Seniors At Risk (ISAR), the Flemish version of the Triage
Risk Screening Tool (TRST), and the Variable Indicative of Placement
Risk (VIP) to predict hospital readmission, alone or in combination
with mortality, in hospitalized patients aged 75 years or older.
Methods: Multicenter prospective cohort study with 30 days follow-up
in 25 general hospitals in Belgium. Baseline data were gathered
within 72 hours of admission. Readmission was defined as an unplanned
hospital stay of at least 24 hours. Information was gathered
by a nurse through patient or proxy interview at admission and
through phone-call at follow-up. Eight hundred and sixty-eight questionnaires
with complete screening were returned. Data of hospital
readmission was available for 72.6% (n=630) of the patients. Besides
analyses in surviving patients only (n=588), combined endpoint
analyses (readmitted or dead) were performed.
Results: Respectively 12.2% (n=72/588) and 6.7% (n=42/630) of
the patients were readmitted or died within 30 days after hospital discharge.
Sensitivity and NPV to predict readmission was high for
ISAR cut off ≥2 (86% and 90%, resp.), TRST cut off ≥2 (71% and
86%, resp.) and VIP cut off ≥1 (60% and 89%, resp.). Increasing the
cut off score with one point had a positive effect on the specificity, but
at the expense of the sensitivity for all three screening tools (69% for
ISAR, 60% for VIP and 40.4% for TRST). Results of the combined
endpoint analyses are shown in the table.
Conclusion: All screening instruments showed good sensitivity
and NPV, the two major characteristics for good screening tools, but
hospital readmission alone or in combination with mortality in older
patients seemed to be most accurately predicted by using the ISAR
cut off ≥3. False positives could be filtered out according to the clinical
expert opinion of a care team.
D33
Increased risk of hospital admission in Patients 65 years and older
presenting to the emergency department.
M. S. Radeos, I. Kariolis, A. Wasserman, K. Joshi, Z. Huang.
Emergency Medicine, New York Hospital Queens, Flushing, NY.
Background: US Emergency department (ED) visits by those 65
years and older account for an estimated 17.5 million visits, or approximately
15% of all visits. About 10.6 million of these are by those
75 years and older.
Objective: We sought to determine factors increase the risk of
hospital admission among adults aged 65 years and older who present
to the ED.
Methods: Research associate (RA) administered a survey to a
convenience sample of adults 65 years and older presenting to a
Level I trauma center. We collected demographic and clinical variables.
We present data as percentages and medians with interquartile
range (IQR). We tested the
univariate association with admission using t-test. Kruskal-Wallis,
chi-square and fisher exact test as appropiate. We ran logistic regression
models with 95% confidence intervals (CI).
Results: We enrolled 1,329 subjects between 1/2010 and 11/2011.
376 (28%) were age 65-74 and 953 (72%) were 75 and older. 59%
were female, and 80% had either Medicare or Medicare plus a supplement.
Race/ethnicity was 61% White, 12% Black, 11% Latino, and
13% Asian. 15% had limited English proficiency. 56% of patients
were admitted. 90% of patients lived independently. 92% had a PMD
or regular health care provider (HCP). In a logistic model that included
age categorory (65-74 versus 75+) sex, race, mode of arrival,
living independently and prior visit to and ED or urgent care center
within the previous week, only the previous ED or urgent care visit in
the previous week was statistically significant, [OR 1.63, 95% CI
[1.08, 2.44) P=0.019]
Conclusion: Older patients who present to the ED have a very
high admission rate suggesting a high acuity. Those who return to the
ED within a week of ED or urgent care visit are at increased risk of
admission to the hospital. This finding underestimates the true acuity,
as many patients receive acute care and may be safely discharged
to home. Future research should focus on interventions in this high
risk group.
D34
Psychiatric Emergencies in the Suburbs: An EMS Response to the
Distressed Senior.
J. J. Bernick, 1,2 D. Dalbey, 2 M. Lester. 2 1. Internal Medicine, San
Jacinto Methodist Hospital, Baytown, TX; 2. Emergency Medical
Service, Health Department, City of Baytown, TX.
Background: When confronted with the confused and agitated
senior patient appreciation of their history and immediate medical
status supply essential insight for patient stabilization. Geriatric patients
with various chronic conditions, multiple medications, and limited
functional reserve display increased susceptibility to psychiatric
problems. The EMS frequently provides the initial evaluation of the
distressed patient manifesting behavioral disorders. This study objective
proposed to review and convey an awareness of the initial assessment
of seniors with diverse psychiatric emergencies.
Methods: This investigation examined the records of a suburban
EMS in Harris County, Texas during a 46 month period commencing
in January, 2008. The field encounters of community residing patients
at least 60 years old receiving evaluation for psychiatric emergencies
were analyzed. The EMS team recorded patient’s primary symptoms,
history and physical findings, procedures performed, and response to
their initial treatment. Event chronology considered the decision to
transport the patient to the hospital.
Results: During the study period, 206 geriatric patients obtained
evaluation for psychiatric emergencies accounting for 11% of psychiatric
calls. Anxiety disorders were the most common diagnosis presenting
in (64)seniors (31% of calls) and the majority required hospital
transport. The EMS treated patients (33) for both drug overdose
and medication withdrawal. The presence of suicidal ideations(13%
of calls), psychotic behavior(12%), and delirium(12%) affected a significant
proportion of seniors requiring EMS care. The EMS attended
an unexpected number of patients (8) threatening a weapon assault.
Approximately 35% of patients receiving EMS triage acknowledged
previous psychiatric disorders.
Conclusion: The appearance of psychiatric symptoms in geriatric
patients develops with dementia,adverse medication reactions,and family
disputes. However, diminishing functional capacity creates an opportunity
for behavioral issues to arise without prior warning. Caregivers
often rely upon the EMS as the initial responder to meet their crisis.
Health professionals early recognition and treatment of senior’s psychiatric
issues enhances support to caregivers, promotes accurate physician
treatment, and improves coordination of care among the health team.
D35
Emergency Department Prescribing and Continuity.
L. Ragsdale, 1 C. Horney, 2 K. Schmader, 2 S. N. Hastings. 2 1. Surgery,
Duke University, Durham, NC; 2. Medicine, Duke University,
Durham, NC.
Supported By: This research was conducted while Dr. Hastings was
supported by a VA HSR&D Career Development Award (RCD
06-019).
Background
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AGS 2012 ANNUAL MEETING