Influence of type of household on prognosis at one year in patients ≥65 years attending hospital emergency departments in Spain. The EDEN-6 study.

Autor: Alquézar-Arbé A; Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: aalquezar@santpau.cat., Osorio GI; Área de Urgencias, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: GOsorio@clinic.cat., Jacob J; Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: jjacob@bellvitgehospital.cat., García-Lamberechts EJ; Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain., Piñera Salmerón P; Emergency Department, Hospital General Universitario Reina Sofía, Murcia, Spain., Llorens P; Emergency Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain. Electronic address: llorens_ped@gva.es., Burillo-Putze G; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain., Requena AC; Emergency Department, Hospital Reina Sofía, Córdoba, Spain., Gil A; Emergency Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain., Fernández C; Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain., Aguiló S; Área de Urgencias, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: Saguilo@clinic.cat., Jiménez S; Área de Urgencias, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: SJimenez@clinic.cat., Escudero Blázquez B; Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain., Rosendo Mesino D; Emergency Department, Hospital Universitario Infanta Cristina, Madrid, Spain., Mojarro EM; Emergency Department, Hospital Santa Tecla, Tarragona, Spain., Vaswani-Bulchand A; Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain., Rodríguez-Cabrera M; Emergency Department, Hospital Norte Tenerife, Spain., Alarcón Martínez P; Emergency Department, Hospital General Universitario Reina Sofía, Murcia, Spain., Gioya GD; Emergency Department, Hospital Universitario del Henares, Madrid, Spain., Alemany González FX; Área de Urgencias, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: falemany@clinic.cat., González Tejera M; Emergency Department, Hospital General Universitario de Elche, Spain., Bóveda García M; Emergency Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: boveda_mar@gva.es., Espinosa Fernández B; Emergency Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain., Llopis F; Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fllopis@bellvitgehospital.cat., Suero Méndez C; Emergency Department, Hospital de la Axarquia de Velez-Malaga, Spain., González Del Castillo J; Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain., Miró Ò; Área de Urgencias, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: omiro@clinic.cat.
Jazyk: angličtina
Zdroj: Maturitas [Maturitas] 2023 Dec; Vol. 178, pp. 107852. Date of Electronic Publication: 2023 Sep 22.
DOI: 10.1016/j.maturitas.2023.107852
Abstrakt: Objective: To investigate whether the type of household is associated with prognosis at one year in patients ≥65 years of age discharged after medical consultation requiring emergency department care.
Methods: Data from the Emergency Department and Elder Needs (EDEN) cohort were used. This retrospective cohort included all patients ≥65 years of age seen in 52 Spanish emergency departments over one week (April 1-7, 2019) in whom the type of household was recorded and categorized as living at home alone, with relatives, with professional caregivers, or in a nursing home. Patient demographic and other baseline characteristics and management during the index emergency department episode were recorded and used to adjust the following 1-year outcomes: all-cause mortality, hospitalization and emergency department revisit. Associations between type of household and outcomes are expressed as adjusted hazard ratios with 95% confidence intervals using living alone as the reference category.
Results: 13,442 patients with a median age of 79 years (interquartile range 72-86) were included; 56% were women, 12.2% of patients lived alone, 74.9% with relatives, 3.9% with a professional caregiver, and 9.1% in a nursing home. During the year following discharge, the mortality rate was 14.0%, the hospitalization rate 29.7%, and the emergency department revisit rate 59.3%. In the fully adjusted model, the risk of death was associated only with living in a nursing home (hazard ratio 1.366 (1.101-1.695)). On the other hand, the risk of hospitalization was lower in individuals living in nursing homes (hazard ratio 0.783 [0.676-0.907]) and at home with relatives (hazard ratio 0.897 [0.810-0.992]), while the risk of emergency department revisit was lower in individuals living in nursing homes (hazard ratio 0.826 [0.742-0.920]) or at home with caregivers (hazard ratio 0.856 [0.750-0.976]).
Conclusion: The type of household was modestly associated with the one-year prognosis of patients ≥65 years of age discharged after attendance at an emergency department. Living in a nursing home is associated with an increased risk of death but a decreased risk of rehospitalization or emergency department revisit, while living at home with relatives or professional caregivers is associated only with a decreased risk of hospitalization and emergency department revisit, respectively.
Competing Interests: Declaration of competing interest The authors declare that they have no competing interest.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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