The association of sepsis with level of care among older people presenting to the emergency department – A national register study in Sweden

Background

Sepsis is potentially fatal and commonly affects older people. However, little is known of the association between surviving sepsis and older patients’ autonomy and dependency following hospital discharge.

Methods

A population-based register study using data from five Swedish national registers included emergency department (ED) visits and in-hospital admission of patients aged 65 years of age and older years with infection or sepsis between 2013 and 2020. The consumption of home care services and residential care, as well as mortality, was examined 1, 6 and 12 months after hospital discharge using mixed models.

Findings

166,188 ED visits with sepsis (23 %) and non-sepsis infections (77 %). Sepsis was associated with an increased risk of becoming dependent on home care (RR=1.09 [1.03–1.15]), residential care (RR=1.05 [1.0–1.1]) and mortality (RR=1.96 [1.89–2.03]) 12 months after in-hospital discharge compared to being diagnosed with infection only. The level of care one month prior to the index ED visit, among the study population, i.e., patients having attended the ED with sepsis and infection, was associated with risk of sepsis OR = 1.31 [1.27–1.35] for patients dependent on home care, and OR = 2.16 [2.09–2.23] for patients dependent on residential care as compared to patients independent on home care.

Interpretation

The current study suggests that sepsis is a major debilitating condition in older survivors, and many patients do not recover former dependency levels, one year after discharge as well as an increased mortality risk. Also, prior dependency on home care or residential care was a risk factor for sepsis for those patients who attended the ED with sepsis and infection.

Funding

Funding was obtained through Örebro University, Sweden and the Research Committee of Region Örebro Län, Sweden.