Nursing Home Residents' Functional Trajectories and Mortality After a Transfer to the Emergency Department.
OBJECTIVE
To describe nursing home residents' (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED).


DESIGN
Case-control observational multicenter study.


SETTING AND PARTICIPANTS
In total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016.


METHODS
Finite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions.


RESULTS
Trajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2‒time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness.


CONCLUSIONS AND IMPLICATIONS
Identified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.
['Guion|Vincent|V|', 'De Souto Barreto|Philipe|P|', 'Rolland|Yves|Y|']
D000203:Activities of Daily Living D000368:Aged D004636:Emergency Service, Hospital D005602:France D006760:Hospitalization D006801:Humans D009735:Nursing Homes
Nursing home residents mortality emergency department functional ability resilience robustness