Short- and long-term characteristics and outcomes in patients aged 65 or older living in nursing homes. EDEN-40 study

Abstract

Objective

To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.

Methods

Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.

Results

A total of 23,629 patients were analyzed, of which 1569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11,330 (95% CI 8967–14,314); ambulation with assistance, OR 5687 (95% CI 4759–6796); cognitive impairment, OR 2802 (95% CI 2448–3208); and age over 85 years, OR 2191 (95% CI 1821–2636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1472 (95% CI 1236–1753) and 1421 (95% CI 1282–1576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.

Conclusions

Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.