Determinants of self-rated health in older adults before and 3 months after an emergency department visit: a prospective study.
Study Goal
The researchers aimed to identify factors associated with a decline in self-rated health (SRH) in older patients after an emergency department visit, including the use of walking devices.
Results Summary
The study found that using a walking device was an independent predictor of decline in SRH (OR 1.70). Patients with functional decline showed a steeper decline in SRH compared to those without functional decline.
Population
Older patients (≥70 years) who visited the emergency department in the Netherlands.
Effective Dosage
Not specified
Duration
3 months
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
ED visit | decrease | self-rated health (SRH) | older patients (≥ 70 years) | - | decline in | #1 |
male gender | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 1.83 | independent predictor of decline in | #2 |
living alone | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 1.56 | independent predictor of decline in | #3 |
living in residential care or nursing home | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 2.75 | independent predictor of decline in | #4 |
number of different medications | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 1.08 | independent predictor of decline in | #5 |
using a walking device | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 1.70 | independent predictor of decline in | #6 |
Katz-ADL score | decrease | self-rated health (SRH) | older patients (≥ 70 years) | OR 1.22 | independent predictor of decline in | #7 |
functional decline | decrease | mean self-rated health (SRH) | patients 3 months after an ED visit | 0.68 points | shows a steeper decline in | #8 |
no functional decline | decrease | mean self-rated health (SRH) | patients 3 months after an ED visit | 0.12 points | shows a decline in | #9 |
OBJECTIVES: Self-rated health (SRH) is an important patient-reported outcome, but little is known about SRH after a visit to the emergency department (ED). We investigated the determinants of decline in SRH during 3 months after an ED visit in older patients. DESIGN: This was a multicenter prospective cohort study including acutely presenting older ( ≥ 70 years) patients in the ED (the Netherlands). Patients were asked to self-rate their health between 0 and 10. The main outcome was a decline in SRH defined as a transition of a SRH of at least 6 to a SRH of less than 6, 3 months after the patient's visit to the ED. RESULTS: Three months after the ED visit, 870 (71.4%) patients had a stable SRH and 209 (11.5%) patients declined in SRH. Independent predictors with a decline in SRH were: male gender (OR 1.83) living alone (OR 1.56), living in residential care or nursing home (OR 2.75), number of different medications (OR 1.08), using a walking device (OR 1.70), and the Katz-ADL score (OR 1.22). Patients with functional decline 3 months after an ED visit show a steeper decline in the mean SRH (0.68 points) than patients with no functional decline (0.12 points, P < 0.001). CONCLUSION: Decline in SRH after an ED visit in older patients is at least partly dependent on factors of functional capacity and functional decline. Preventive interventions to maintain functional status may be the solution to maintain SRH, but more research is needed to further improve and firmly establish the clinical usability of these findings.