Acute Care Use and Prognosis in Older Adults Presenting to the Emergency Department

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CONTEXT: Understanding how prognosis influences acute care use among older adults at risk of short-term mortality is essential for providing care consistent with patients' wishes. OBJECTIVES: This study assesses whether prognosis is associated with acute care and Intensive Care Unit (ICU) transfer in older adults presenting to the Emergency Department (ED) at high and low risk of short-term mortality. METHODS: For this cross-sectional analysis, we pooled the Medicare claims for older adults 66 years and older from 2015 to 2019 who visited at least one of the 29 EDs participating in the Primary Palliative Care for Emergency Medicine study. Our outcome measures were defined as an acute care admission and ICU transfer resulting from an ED visit, both measured as binary variables. The predictor variables were age, sex, race/ethnicity, and Gagne score. We stratified the analysis into those with low (≤6) and high risk (>6) short-term mortality using the Gagne scores. To assess the odds of an acute care or ICU transfer, we used multivariable logistic regression via generalized estimating equation models and computed the adjusted odds ratios (AOR) among the general population and among those at high risk of short-term mortality. RESULTS: Of the 301,083 older adults who visited one of the 29 EDs, 13% were at high risk for short-term mortality. Among this high-risk group, 64% had an acute care admission, and 15% of those admitted had an ICU transfer, as compared to 43% and 12% of those at low risk of short-term mortality. Among those at high risk for short-term mortality, prognosis was associated with 6% (AOR 1.06; 95% CI, 1.04-1.09) and 8% (AOR 1.08; 95% CI, 1.06-1.09) increased adjusted odds of inpatient admission and ICU transfer, respectively. CONCLUSION: The prognosis of older adults, especially those at high risk of short-term mortality, predicts both inpatient admissions and ICU transfers.

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