Analysis of traumatic event emergency department visits among care home residents aged 65 + years in Southern Jutland, Denmark: implications for comprehensive care and subsequent hospital admissions - a register-based cohort study.
Acute admission
Care home
Casualty
Emergency department
Injury
Nursing home
Older adults
Register-based
Traumatic events
Treat and release
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
28 May 2024
28 May 2024
Historique:
received:
13
10
2023
accepted:
17
05
2024
medline:
29
5
2024
pubmed:
29
5
2024
entrez:
28
5
2024
Statut:
epublish
Résumé
Care home residents aged 65 + years frequently experience acute health issues, leading to emergency department visits. Falls and associated injuries are a common cause of these visits and falls in a geriatric population can be a symptom of an incipient acute illness such as infection. Conversely, the traumatic event can cause illnesses to arise due to consequences of the fall, e.g. delirium or constipation due to opioid use. We hypothesised that a traumatic event treat-and-release emergency department visit serves as an indicator for an upcoming acute hospital admission due to non-trauma-related conditions. We studied emergency department visits for traumatic events among all care home residents aged 65+ (n = 2601) living in Southern Jutland, Denmark, from 2018 to 2019. Data from highly valid national registers were used to evaluate diagnoses, mortality, and admissions. Cox Regression was used to analyse the hazard of acute hospital admission following an emergency department treat-and-release visit. Most visits occurred on weekdays and during day shifts, and 72.0% were treated and released within 6 h. Contusions, open wounds, and femur fractures were the most common discharge diagnoses, accounting for 53.3% of all cases (n = 703). In-hospital mortality was 2.3%, and 30-day mortality was 10.4%. Among treat-and-release visits (n = 506), 25% resulted in a new hospital referral within 30 days, hereof 13% treat-and-release revisits (duration ≤ 6 h), and 12% hospital admissions (duration > 6 h). Over half (56%) of new hospital referrals were initiated within the first seven days of discharge. Almost three-fourths of subsequent admissions were caused by various diseases. The hazard ratio of acute hospital admissions was 2.20 (95% CI: 1.52-3.17) among residents with a recent traumatic event treat-and-release visit compared to residents with no recent traumatic event treat-and-release visit. Traumatic event treat-and-release visits among care home residents serve as an indicator for subsequent hospitalisations, highlighting the need for a more comprehensive evaluation, even for minor injuries. These findings have implications for improving care, continuity, and resource utilisation. Not relevant.
Sections du résumé
BACKGROUND
BACKGROUND
Care home residents aged 65 + years frequently experience acute health issues, leading to emergency department visits. Falls and associated injuries are a common cause of these visits and falls in a geriatric population can be a symptom of an incipient acute illness such as infection. Conversely, the traumatic event can cause illnesses to arise due to consequences of the fall, e.g. delirium or constipation due to opioid use. We hypothesised that a traumatic event treat-and-release emergency department visit serves as an indicator for an upcoming acute hospital admission due to non-trauma-related conditions.
METHODS
METHODS
We studied emergency department visits for traumatic events among all care home residents aged 65+ (n = 2601) living in Southern Jutland, Denmark, from 2018 to 2019. Data from highly valid national registers were used to evaluate diagnoses, mortality, and admissions. Cox Regression was used to analyse the hazard of acute hospital admission following an emergency department treat-and-release visit.
RESULTS
RESULTS
Most visits occurred on weekdays and during day shifts, and 72.0% were treated and released within 6 h. Contusions, open wounds, and femur fractures were the most common discharge diagnoses, accounting for 53.3% of all cases (n = 703). In-hospital mortality was 2.3%, and 30-day mortality was 10.4%. Among treat-and-release visits (n = 506), 25% resulted in a new hospital referral within 30 days, hereof 13% treat-and-release revisits (duration ≤ 6 h), and 12% hospital admissions (duration > 6 h). Over half (56%) of new hospital referrals were initiated within the first seven days of discharge. Almost three-fourths of subsequent admissions were caused by various diseases. The hazard ratio of acute hospital admissions was 2.20 (95% CI: 1.52-3.17) among residents with a recent traumatic event treat-and-release visit compared to residents with no recent traumatic event treat-and-release visit.
CONCLUSION
CONCLUSIONS
Traumatic event treat-and-release visits among care home residents serve as an indicator for subsequent hospitalisations, highlighting the need for a more comprehensive evaluation, even for minor injuries. These findings have implications for improving care, continuity, and resource utilisation.
TRIAL REGISTRATION
BACKGROUND
Not relevant.
Identifiants
pubmed: 38807046
doi: 10.1186/s12877-024-05092-0
pii: 10.1186/s12877-024-05092-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
465Informations de copyright
© 2024. The Author(s).
Références
Tanderup A, Ryg J, Rosholm J-U, et al. Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study. BMJ Open. 2019;9:e026881. https://doi.org/10.1136/bmjopen-2018-026881 .
doi: 10.1136/bmjopen-2018-026881
pubmed: 31023760
pmcid: 6501979
Graverholt B, Riise T, Jamtvedt G, et al. Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Serv Res. 2011;11:126. https://doi.org/10.1186/1472-6963-11-126 .
doi: 10.1186/1472-6963-11-126
pubmed: 21615911
pmcid: 3112397
Danish Ministry of Health. National undersøgelse af forholdene på plejecentre [National study of conditions in nursing home facilities]. https://sm.dk/publikationer/2016/mar/national-undersoegelse-af-forholdene-paa-plejecentre .
Dwyer R, Gabbe B, Stoelwinder JU, et al. A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing. 2014;43:759–66. https://doi.org/10.1093/ageing/afu117 .
doi: 10.1093/ageing/afu117
pubmed: 25315230
Lemoyne SE, Herbots HH, De Blick D, et al. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr. 2019;19. https://doi.org/10.1186/s12877-019-1028-z .
Kirsebom M, Hedström M, Wadensten B, et al. The frequency of and reasons for acute hospital transfers of older nursing home residents. Arch Gerontol Geriatr. 2014;58:115–20. https://doi.org/10.1016/j.archger.2013.08.002 . 2013/09/11.
doi: 10.1016/j.archger.2013.08.002
pubmed: 24016467
Gruneir A, Bell CM, Bronskill SE, et al. Frequency and pattern of Emergency Department visits by long-term care Residents-A Population-based study. J Am Geriatr Soc. 2010;58:510–7. https://doi.org/10.1111/j.1532-5415.2010.02736.x .
doi: 10.1111/j.1532-5415.2010.02736.x
pubmed: 20398120
Fassmer AM, Pulst A, Schmiemann G, et al. Sex-specific differences in Hospital Transfers of Nursing Home Residents: results from the HOspitalizations and eMERgency Department visits of nursing home residents (HOMERN) Project. Int J Environ Res Public Health. 2020;17:3915. https://doi.org/10.3390/ijerph17113915 .
doi: 10.3390/ijerph17113915
pubmed: 32492840
pmcid: 7312075
Heinold S, Fassmer AM, Schmiemann G, et al. Characteristics of outpatient emergency department visits of nursing home residents: an analysis of discharge letters. Aging Clin Exp Res. 2021;33:3343–51. https://doi.org/10.1007/s40520-021-01863-6 .
doi: 10.1007/s40520-021-01863-6
pubmed: 33939126
pmcid: 8668845
World Health Organization. WHO Global Report on Falls Prevention in Older Age. https://www.who.int/publications/i/item/9789241563536 .
Spaniolas K, Cheng JD, Gestring ML, et al. Ground level falls are associated with significant mortality in elderly patients. J Trauma. 2010;69:821–5. https://doi.org/10.1097/TA.0b013e3181efc6c6 . 2010/10/13.
doi: 10.1097/TA.0b013e3181efc6c6
pubmed: 20938268
Immonen M, Haapea M, Similä H, et al. Association between chronic diseases and falls among a sample of older people in Finland. BMC Geriatr. 2020;20. https://doi.org/10.1186/s12877-020-01621-9 .
Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing, 2006; 35 Suppl 2: ii37-ii41. 2006/08/24. https://doi.org/10.1093/ageing/afl084 .
Galet C, Zhou Y, Ten Eyck P, et al. Fall injuries, associated deaths, and 30-day readmission for subsequent falls are increasing in the elderly US population: a query of the WHO mortality database and National Readmission Database from 2010 to 2014. Clin Epidemiol. 2018;10:1627–37. https://doi.org/10.2147/clep.s181138 .
doi: 10.2147/clep.s181138
pubmed: 30519111
pmcid: 6233862
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994;121:442–51. https://doi.org/10.7326/0003-4819-121-6-199409150-00009 . 1994/09/15.
doi: 10.7326/0003-4819-121-6-199409150-00009
pubmed: 8053619
Vassallo M, Sharma J. Incidence and prognostic implications of falls associated with acute medical illness: a medical inpatient study. Int J Clin Pract. 1998;52:233–5. https://doi.org/10.1111/j.1742-1241.1998.tb11615.x .
doi: 10.1111/j.1742-1241.1998.tb11615.x
pubmed: 9744146
Earl-Royal EC, Kaufman EJ, Hanlon AL, et al. Factors associated with hospital admission after an emergency department treat and release visit for older adults with injuries. Am J Emerg Med. 2017;35:1252–7. 2017/04/16.
doi: 10.1016/j.ajem.2017.03.051
pubmed: 28410919
pmcid: 5854494
Kristensen GS, Wolff DL, Søndergaard J, et al. Exploring the validity of identifying care home residents through a new national register. Scand J Public Health. 2022;140349482210810. https://doi.org/10.1177/14034948221081071 .
Schmidt M, Pedersen L, Sørensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29:541–9. https://doi.org/10.1007/s10654-014-9930-3 .
doi: 10.1007/s10654-014-9930-3
pubmed: 24965263
Schmidt M, Schmidt SA, Sandegaard JL, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–90. 2015/11/26.
doi: 10.2147/CLEP.S91125
pubmed: 26604824
pmcid: 4655913
The Danish Ministry of Social Affairs. Serviceloven [Law on Social Services]. https://www.retsinformation.dk/eli/lta/2023/1089 . 192 and 192a.
Statistics Denmark. Statbank table FOLK1A - Folketal den 1. i kvartalet [Population demographics 4th quarter of 2019]. https://www.statistikbanken.dk/10022 . Accessed 2024.03.29.
Statistics Denmark. Statbank table RESI01 - Indskrevne i pleje- og ældreboliger [Enrollment in nursing homes and senior housing]. https://www.statistikbanken.dk/resi01 . Accessed 2023.02.03.
Danish Health Data Authority. Plejehjemsoversigten [Overview of Nursing Homes]. https://plejehjemsoversigten.dk/ . Accessed 2024.02.01.
Ministry of Health. Healthcare in Denmark - an overview. https://healthcaredenmark.dk/news-publications/publications/healthcare-in-denmark-an-overview/#:~:text=The%20 Danish%20healthcare%20system%20is,are%20financed%20by%20general%20taxes.
Andersen PK, Perme MP, van Houwelingen HC, et al. Analysis of time-to-event for observational studies: Guidance to the use of intensity models. Stat Med. 2021;40:185–211. https://doi.org/10.1002/sim.8757 .
doi: 10.1002/sim.8757
Thygesen LC, Daasnes C, Thaulow I, et al. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health. 2011;39:12–6. https://doi.org/10.1177/1403494811399956 . 2011/09/08.
doi: 10.1177/1403494811399956
pubmed: 21898916
Kristensen GS, Kjeldgaard AH, Søndergaard J, et al. Associations between care home residents’ characteristics and acute hospital admissions – a retrospective, register-based cross-sectional study. BMC Geriatr. 2023;23:234. https://doi.org/10.1186/s12877-023-03895-1 .
doi: 10.1186/s12877-023-03895-1
pubmed: 37072701
pmcid: 10114422
Unroe KT, Caterino JM, Stump TE, et al. Long-stay nursing facility Resident transfers: who gets admitted to the hospital? J Am Geriatr Soc. 2020;68:2082–9. https://doi.org/10.1111/jgs.16633 .
doi: 10.1111/jgs.16633
pubmed: 33460101
Danish Health Data Authority. Health data and registers. https://sundhedsdatastyrelsen.dk/da/english/health_data_and_registers .
Capital Region of Denmark. Model for behandlingsansvar 72 timer efter hospitalsbehandling [Model for responsibility for patient care 72 hours after hospital discharge]. www.regionh.dk/til-fagfolk/Sundhed/Tvaersektorielt-samarbejde/Documents/Til%20nettet%20Aftale%20om%2072%20timers%20behandlingsansvar%20version%203.0.pdf . Accessed 05 April 2024.