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Text
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<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">http://doi.org/10.1111/j.1553-2712.2010.00799.x</a>
Pages
679–686
Issue
7
Volume
17
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Title
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Short-term functional decline and service use in older emergency department patients with blunt injuries.
Publisher
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Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Date
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2010
2010-07
Subject
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*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
Creator
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Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Description
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BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
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<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Activities of Daily Living
2010
80 and over
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Academic Medical Centers
Activities of Daily Living
Aged
Allen Kyle R
Blanda Michelle
Bone/physiopathology/therapy
Clinical Assessment Tools
Comorbidity
Confidence Intervals
Department of Emergency Medicine
Descriptive Statistics
Emergency Care – In Old Age
Emergency Patients – In Old Age
Emergency Service
Family
Female
Fisher's Exact Test
Fractures
Functional Status – In Old Age
Geriatric Assessment
Geriatric Functional Assessment
Gerson Lowell W
Health Resource Utilization – In Old Age
Hospital/*statistics & numerical data
Hospitals
Human
Humans
Logistic Models
Logistic Regression
Longitudinal Studies
Male
Mental Status Schedule
NEOMED College of Medicine
Nonpenetrating – In Old Age
Nonpenetrating/*physiopathology/*therapy
OARS Multidimensional Functional Assessment Questionnaire
Odds Ratio
Ohio
Outcome Assessment
Outpatients
P-Value
Predictive Value of Tests
Prospective Studies
Questionnaires
Record Review
ROC Curve
Scales
Summated Rating Scaling
Surveys and Questionnaires
T-Tests
Teaching
Treatment Outcome
Treatment Outcomes
Wilber Scott T
Wounds