老年学与老年病学研究

抽象的

Recommendations for the Management of Geriatric Patients Visiting Emergency Department and Risk of Death: An Observational Cohort Study

Cyrille P Launay*, E Jaunin, Frédéric Scholastique, Helene Riviere, Julia Chabot and Olivier Beauchet

Objective: To examine the effects of geriatric and gerontological recommendations for the management of geriatric patients visiting an emergency department (ED) on risk of death in the first year following the ED visit.

Methods: A total of 131 geriatric patients who visited Angers University hospital ED were prospectively included in this observational cohort study. They were separated in three groups matched on age and gender: two intervention groups (11 patients with geriatric recommendations and 23 patients with gerontological recommendations) and one control group (97 patients without any recommendations). Intervention was provided upon the participant’s ED admission. Incident mortality was collected via the administrative registry of Hospital before patients’ discharge and via a systematic phone call 12 month after the ED visit. Age, gender, place of living, number of daily drugs taken, cognitive decline, and reason for ED admission were used as covariates.

Results: Multiple Cox regression model showed that gerontological recommendations were associated with a lower rate of mortality (adjusted Hazard Ratio [HR]=0.12, P=0.038) but not geriatric recommendations (adjusted HR=9.94, P=0.905). Living at home was associated with a greater risk of death (adjusted HR=2.55 with P=0.020). Kaplan-Meier distributions of mortality confirmed that patients who received gerontological recommendations had a lower mortality rate compared to those who did no received recommendations (P=0.005) and those who received geriatric recommendations (P=0.015).

Discussion and Conclusion: Our findings show that gerontological, but not geriatric recommendations were associated with a lower risk of mortality after an ED visit in geriatric patients.