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Factors associated with re-presentation to emergency departments in elderly people with pain.
Aust Health Rev. 2014 Sep;38(4):461-6
Authors: Howard R, Hannaford A, Weiland T
Abstract
OBJECTIVES: To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain.
METHODS: We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital's rapid response, assessment and care planning program for elderly people.
RESULTS: Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P=0.003); (2) the presence of Home and Community Care Services (P=0.03); and (3) the absence of a gait aid (P=0.019). Nineteen per cent of eligible patients re-presented to ED within 30 days of initial presentation.
CONCLUSION: These findings contribute to current debate about opioid prescription and effective pain management in the elderly. The study highlights the need for routine follow-up care of older people discharged from the ED with pain, particularly those discharged home with opioids or with complex care needs.
PMID: 25001231 [PubMed - indexed for MEDLINE]