Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study
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RESEARCH ARTICLE
Open Access
Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study Anne-Laure Feral-Pierssens1,2,3*, Gustave Toury1, Fatima Sehimi4, Nicolas Peschanski5, Saïd Laribi6,7, Amélie Carpentier8, Magali Kraif9, Clément Carbonnier10,11, François-Xavier Duchateau12, Yonathan Freund2,13,14, Philippe Juvin1,2,15 and the EPIGER IRU-SFMU study group16
Abstract Background: For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources’ use and patients’ outcome. Methods: A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for “having difficulties coping at home”. The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints. Results: One thousand one hundred sixty-eight patients were included, median age 86(83–89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68–2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65–1.30]). Assisted patients had a lower risk of being admitted for “having difficulties coping at home” (OR = 0.59;95%CI [0.38–0.92]). (Continued on next page)
* Correspondence: [email protected] 1 Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France 2 IMProving Emergency Care academic federation, Paris, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any me
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