TY  - JOUR
AU  - Alvarez Avendano, Sebastian Alejandro
AU  - Cochran, Amy
AU  - Odeh Couvertier, Valerie
AU  - Patterson, Brian
AU  - Shah, Manish
AU  - Zayas-Caban, Gabriel
PY  - 2025
DA  - 2025/2/6
TI  - Revisits, Readmission, and Mortality From Emergency Department Admissions for Older Adults With Vague Presentations: Longitudinal Observational Study
JO  - JMIR Aging
SP  - e55929
VL  - 8
KW  - gerontology
KW  - geriatric
KW  - older adults
KW  - elderly
KW  - older people
KW  - aging
KW  - emergency department
KW  - emergency room
KW  - ED
KW  - disposition decision
KW  - disposition
KW  - discharge
KW  - admission
KW  - revisit
KW  - readmission
KW  - observational study
KW  - health
KW  - hospital
AB  - Background: Older adults (65 years and older) often present to the emergency department (ED) with an unclear need for hospitalization, leading to potentially harmful and costly care. This underscores the importance of measuring the trade-off between admission and discharge for these patients in terms of patient outcomes. Objective: This study aimed to measure the relationship between disposition decisions and 3-day, 9-day, and 30-day revisits, readmission, and mortality, using causal inference methods that adjust for potential measured and unmeasured confounding. Methods: A longitudinal observational study (n=3591) was conducted using electronic health records from a large tertiary teaching hospital with an ED between January 1, 2014 and September 27, 2018. The sample consisted of older adult patients with 1 of 6 presentations with significant variability in admission: falls, weakness, syncope, urinary tract infection, pneumonia, and cellulitis. The exposure under consideration was the ED disposition decision (admission to the hospital or discharge). Nine outcome variables were considered: ED revisits, hospital readmission, and mortality within 3, 9, and 30 days of being discharged from either the hospital for admitted patients or the ED for discharged patients. Results: Admission was estimated to significantly decrease the risk of an ED revisit after discharge (30-day window: −6.4%, 95% CI −7.8 to −5.0), while significantly increasing the risk of hospital readmission (30-day window: 5.8%, 95% CI 5.0 to 6.5) and mortality (30-day window: 1.0%, 95% CI 0.4 to 1.6). Admission was found to be especially adverse for patients with weakness and pneumonia, and relatively less adverse for older adult patients with falls and syncope. Conclusions: Admission may not be the safe option for older adults with gray area presentations, and while revisits and readmissions are commonly used to evaluate the quality of care in the ED, their divergence suggests that caution should be used when interpreting either in isolation. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2025/1/e55929
UR  - https://doi.org/10.2196/55929
DO  - 10.2196/55929
ID  - info:doi/10.2196/55929
ER  -