Many seniors who visit EDs require more assistance with physical tasks than they think they do, which might lead to hospital readmission later on, according to a new study.
Findings were published Aug. 7 on the website of the Annals of Emergency Medicine.
“Ensuring that older adults discharged from the emergency department are able to safely function in their home environment is important because those who are unable to function safely at home are at risk for falls and return ER visits,” lead study author Timothy Platts-Mills, MD, MSc, of the University of North Carolina-Chapel Hill, said in a news release. “Accurately determining the ability of these patients to care for themselves at home is critical for emergency physicians as they make decisions about whether to discharge patients home or elsewhere. A patient who reports they can walk with an assistive device but actually requires human assistance to walk is likely to be bed-bound or to fall if they go home alone.”
For the study, 272 patients ages 65 and older (average age of 75 years) were asked about their abilities to complete several tasks — getting out of bed, walking 10 feet and returning to bed. The participants included 124 seniors who went to the ED at Cooper Medical School of Rowan University in Camden, N.J., and 148 were from the ED at the University of North Carolina in Chapel Hill. Of the full group, 66% were white, 31% had a college education and 29% lived alone.
When researchers asked about their ability to complete the physical task, 59% said they could do the task without assistance, 17% said they could do the task with a cane or walker, 8% said they could do the task if they had assistance, and 17% said they would not be able to do the task even with assistance.
The group of participants who reported they would be unable to complete the task with assistance (45 patients) were not asked to attempt the task. Another 55 participants were not willing to complete the task.
Of the 172 remaining patients who attempted the task, 77% accurately assessed their ability to perform tasks, the study showed. Researchers found 3% underestimated their ability to complete the task and 20% overestimated their ability.
Of patients who said they could perform the assigned tasks without assistance, 12% required some assistance or were unwilling to complete the tasks, the study found. Of those who said they could perform the task with a cane or walker, 48% required either human assistance or were unable to perform the task, researchers found. Of those who said they could perform the task with human assistance, 24% were unable to perform the task even with someone helping them.
“Emergency physicians are experts in deciding who can go home and who needs to come in the hospital,” Platts-Mills said in the release. “But we are not perfect and sometimes we make decisions based on patient statements about abilities, rather than direct assessments. Our results suggest that patient statements are sometimes inaccurate, and, particularly for older adults who need some assistance, directly observing the patient’s ambulation can be informative. Of course being able to move around isn’t the only determinant of whether an older adult can be safely sent home, but it is a critical piece of information and it’s good to get it right.”