Predicting Re-attendance of Older Adults to the Emergency Department

Report By: Dr Tamkeen Pervez ; Dr Rosa McNamara - Specialty Registrar Emergency Medicine; Consultant Emergency Medicine
Search checked by Dr Tamkeen Pervez ; Dr Rosa McNamara - Specialty Registrar Emergency Medicine; Consultant Emergency Medicine
Institution: St. Mary's Hospital London, Imperial College Healthcare NHS Trust
Date Submitted: 10th October 2017
Last Modified: 3rd April 2024
Status: Blue (submitted but not checked)

Three Part Question

TO [identify common characteristics] IN [ older adults presenting to ED] THAT [ can predict re-attendance]

Clinical Scenario

A 70 year-old gentleman has presented to the Emergency Department (ED) for the 3rd time in 7 months. Your SHO insists that he should be admitted or he will just come back again. What factors in his assessment suggest that he is more likely to re-attend?

Search Strategy

i) Systematic literature review
ii) English Language
iii) Electronic Database Search: AMED, ASC, BRC, CINAHL, CINAHL Plus, Embase Classic, EMBASE, HMIC, Journals@OVID, MEDLINE, Psychinfo, Social Sciences Full Text (H.W. Wilson), Global Health , International Pharmaceutical Abstracts, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, PsycARTICLES Full Text, Social Policy and Practice, Ovid OLDMEDLINE, using the OVID and EBSCO interfaces, Google Scholar, and the Cochrane library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials) were also searched.
iv) Includes all publications to June 30th 2015
v) Study Inclusion Criteria: Included patients aged 65 years or older; original data; focused in ED; not limited to specific disease; Study participants were Emergency Department patients; frequent attendance (minimum 4 attendance in 12 months) was one of the outcome measures.

Total articles retrieved 278; Excluded 219; potentially eligible 60; Excluded after review 38; Included in review 22

Search Outcome

Literature review conclusion: there is little work which looks at older adults who frequently attend as a discrete group. More work needed

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Aoyama M, Suzuki Y, Onishi J et al 2011 Japan	58 adults attending the geriatric OPD who were prescreened and considered at high risk of fall, aged ≥65, 100%female	Prospective Cohort (6 months)			Highly select patient group and all female, so not representative of ED population. Results don’t identify a ‘cut-of’ for TUG so unclear how they worked out OR Unable to calculate diagnostic accuracy from data available

Clinical Bottom Line

Clinical Bottom Line: Comorbidity, poly-pharmacy, deprivation and dependency were predictive of frequent attendance in the ED. More work is needed to develop more generalizable and accurate models to predict frequent attendance to the ED Literature review conclusion: there is little work which looks at older adults who frequently attend as a discrete group. More work is needed.

References

Aoyama M, Suzuki Y, Onishi J et al Physical and functional factors in activities of daily living that predict falls in community-dwelling older women Geriatr Gerontol Int 2011;11:348-357