Factors associated with hospitalization from a geriatric short-stay unit (OBI-GER): a retrospective cohort study

Abstract

Background

Geriatric Short-Stay Observation Units (G-SSU) are specialized units designed to improve care for older adults within the emergency department (ED). At our hospital, the Osservazione Breve Intensiva Geriatrica (OBI-GER) was established as a dedicated G-SSU.

Aims

This study aims to characterize the clinical profile of older adults admitted to OBI-GER and identify factors associated with hospitalization within the first 24 h of admission.

Methods

Retrospective, single-center study including individuals aged ≥ 75 years, admitted to OBI-GER between August 2023 and August 2024, with frailty and/or delirium during ED stay. Multivariable logistic regression model with stepwise selection was used to assess associations between hospitalization and clinical, functional, laboratory, and organizational variables.

Results

Overall, 353 patients (mean age 86.8 ± 5.5 years, 47.9% male) were included, of whom 109 (30.8%) required hospitalization. The cohort exhibited moderate frailty (median Clinical Frailty Scale = 6, IQR 6–7) and a considerable comorbidity burden (median Charlson Comorbidity Index [CCI] = 6, IQR 5–8), along with a high prevalence of dementia (45%) and polypharmacy (mean 7.1 ± 3.4 medications). Independent risk factors for hospitalization included higher CCI (OR 1.19, 95% CI 1.05–1.35), delirium on the first day of OBI-GER (OR 2.03, 95% CI 1.13–3.64), frequent faller profile (OR 2.66; 95% CI 1.38–5.12), and lower hemoglobin levels at ED admission (OR 0.89, 95% CI 0.79–0.99).

Conclusions

Despite their clinical complexity, only one-third of patients admitted to OBI-GER required hospitalization. CCI, delirium, fall history, and hemoglobin levels may serve to stratify hospitalization risk and optimize patient selection for G-SSU.