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Original Article
- Characteristics and Mortality Risk Factors in Geriatric Hospital Patients visiting One Region-wide Emergency Department
- Kyoung Wan Kim, Soongnang Jang
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Journal of Korean Academy of Community Health Nursing 2016;27(4):327-336.
DOI: https://doi.org/10.12799/jkachn.2016.27.4.327
Published online: December 31, 2016
1The Catholic University of Korea Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
2Red Cross College of Nursing, Chung-Ang University, Seoul, Korea.
• Received: May 18, 2016 • Revised: November 14, 2016 • Accepted: November 14, 2016
© 2016 Korean Academy of Community Health Nursing
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
-
Purpose
- This study was to examine the clinical characteristics and mortality risk factors of geriatric hospital patients who visited one region-wide emergency department (ED). It's basically meant to develop criteria for the patient management of geriatric hospitals and to provide related information.
-
Methods
- A retrospective research study was implemented using electronic medical records. The subjects in this study included 484 geriatric hospital patients who were selected from among 15,994 patients that visited one region-wide ED between January 1, 2014, and December 31, 2015.
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Results
- There were significant differences in death, a change for the better and no change for the better, which were results of treatment, according to the length of stay in hospital, hospitalization in a general ward, not having an operation or surgery, the presence or absence of malignant neoplasm, the insertion of foley catheter, intubation, ventilator and the insertion of central venous catheter.
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Conclusion
- The results of this study suggest that a patient management system is necessary in geriatric hospitals and that competent healthcare workers who can properly respond to emergencies are required as well.
Table 1
General Characteristics (N=484)
Table 2
Reason for Transfer (N=484)
Table 3
Clinical Characteristics (N=484)
Table 4
Clinical Characteristics & Outcome (N=484)
Table 5
Geriatric Hospital Patients Mortality Risk Factor in Visiting Emergency Department (N=484)
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Characteristics and Mortality Risk Factors in Geriatric Hospital Patients visiting One Region-wide Emergency Department
| Characteristics | Categories | n (%) |
|---|---|---|
| Gender | Female | 251 (51.9) |
| Male | 233 (48.1) | |
| Age (year) | <50 | 21 (4.3) |
| 50~59 | 42 (8.7) | |
| 60~69 | 83 (17.1) | |
| 70~79 | 184 (38.0) | |
| ≥80 | 154 (31.8) | |
| Pain (NRS) | None | 248 (51.2) |
| NRS1~2 | 146 (30.2) | |
| ≥NRS3 | 90 (18.6) | |
| Length of stay for geriatrics (LOS: days) | ≤25.0 | 164 (33.9) |
| 26.0~172.0 | 159 (32.8) | |
| ≥173.0 | 161 (33.3) | |
| Type of admission | General ward | 199 (41.1) |
| ICU | 67 (13.8) | |
| Discharge | 218 (45.0) | |
| Sore | No | 371 (77.0) |
| Yes | 111 (22.9) | |
| Length of stay for hospital (days) | ≤1.0 | 219 (45.3) |
| 2.0~9.0 | 113 (23.4) | |
| ≥10.0 | 152 (31.4) | |
| Outcome | Died | 51 (10.5) |
| Improved | 342 (70.7) | |
| Not improved | 89 (18.4) |
| Variables | n (%) |
|---|---|
| Dyspnea | 78 (16.1) |
| Fever | 46 (9.5) |
| Abdominal discomfort | 42 (8.7) |
| Decreased mentality | 38 (7.9) |
| For blood transfusion | 28 (5.8) |
| Musculoskeletal problem | 28 (5.8) |
| Hematochezia | 27 (5.6) |
| Visual disturbance | 21 (4.3) |
| General weakness | 20 (4.1) |
| Hematemesis | 19 (3.9) |
| Chest discomfort | 17 (3.5) |
| Hypotension | 13 (2.7) |
| Hematuria, gross | 12 (2.5) |
| AVF operation | 11 (2.3) |
| Seizure | 11 (2.3) |
| CRF | 11 (2.3) |
| Concussion | 8 (1.7) |
| Vaginal bleeding | 8 (1.7) |
| Dizziness | 7 (1.4) |
| Cough | 6 (1.2) |
| Pneumonia | 6 (1.2) |
| Dysarthria | 5 (1.0) |
| Pain | 5 (1.0) |
| Dysuria | 4 (0.8) |
| Vomiting | 4 (0.8) |
| Diarrhea | 4 (0.8) |
| Dyspepsia | 3 (0.6) |
| Poor oral intake | 2 (0.4) |
| Characteristics | Categories | n (%) | |
|---|---|---|---|
| HTN | No | 163 (33.7) | |
| Yes | 321 (66.3) | ||
| DM | No | 294 (60.7) | |
| Yes | 190 (39.3) | ||
| Tuberculosis | No | 471 (97.3) | |
| Yes | 13 (2.7) | ||
| Hepatitis | No | 470 (97.1) | |
| Yes | 14 (2.9) | ||
| Heart disease | No | 392 (81.0) | |
| Yes | 90 (18.6) | ||
| Cerebral disease | No | 213 (44.0) | |
| Yes | 271 (56.0) | ||
| Respiratory Disease | No | 448 (92.6) | |
| Yes | 36 (7.4) | ||
| Genitourinary disease | No | 399 (82.4) | |
| Yes | 85 (17.6) | ||
| Neoplasm | No | 419 (86.6) | |
| Yes | 65 (13.4) | ||
| other disease | No | 394 (81.4) | |
| Yes | 90 (18.6) | ||
| Triage Level | 1~2 | 14 (2.9) | |
| 3 | 148 (30.6) | ||
| 4~5 | 306 (63.2) | ||
| Antibiotics use in the geriatric hospital | No | 339 (70.0) | |
| Yes | 134 (27.7) | ||
| Foley catheter | No | 223 (46.1) | |
| Yes | 260 (53.7) | ||
| Endo-tracheal tube | No | 429 (88.6) | |
| Yes | 54 (11.2) | ||
| Ventilator | No | 443 (91.5) | |
| Yes | 40 (8.3) | ||
| Central line | No | 376 (77.7) | |
| Yes | 107 (22.1) | ||
| Tracheotomy | No | 430 (88.8) | |
| Yes | 53 (11.0) | ||
| Operation | No | 450 (93.0) | |
| Yes | 34 (7.0) | ||
| Procedure | No | 308 (63.6) | |
| Yes | 176 (36.4) | ||
| Ex-infection (n=185, 38.2%) | PNEU | No | 379 (78.1) |
| Yes | 105 (21.7) | ||
| BSI | No | 453 (93.4) | |
| Yes | 29 (6.0) | ||
| UTI | No | 437 (90.3) | |
| Yes | 46 (9.5) | ||
| Mental status (AVPU) | Alert | 369 (76.2) | |
| Verbal response | 43 (8.9) | ||
| Painful response | 57 (11.8) | ||
| Unresponsiveness | 15 (3.1) | ||
| Antibiotics treatment on the ED | No | 180 (37.2) | |
| Yes | 304 (62.8) | ||
| Characteristics | Categories | Died (n=51) | Improved (n=342) | Not improved (n=89) | x2 | p |
|---|---|---|---|---|---|---|
| n (%) | n (%) | n (%) | ||||
| Gender | Female | 27 (10.8) | 181 (72.4) | 42 (16.8) | 0.95 | .620 |
| Male | 24 (10.3) | 161 (69.4) | 47 (20.3) | |||
| Triage level | Not known | 0 (0.0) | 2 (66.7) | 1 (1.1) | 13.42 | .037 |
| 1~2 | 24 (14.9) | 98 (60.9) | 39 (33.3) | |||
| 3 | 26 (8.5) | 231 (75.7) | 48 (15.7) | |||
| 4~5 | 1 (7.7) | 11 (84.6) | 1 (7.7) | |||
| Hospital LOS (days) | ≤1.0 | 21 (9.7) | 125 (57.6) | 71 (32.7) | 54.25 | ＜.001 |
| 2.0~9.0 | 13 (11.5) | 90 (79.7) | 10 (8.9) | |||
| ≥10.0 | 17 (11.2) | 127 (83.6) | 8 (5.3) | |||
| Type of admission | General ward | 21 (10.6) | 167 (83.9) | 11 (5.5) | 6.78 | .034 |
| Intensive care unit | 11 (16.4) | 47 (70.2) | 9 (13.4) | |||
| Mental status (AVPU) | Alert | 34 (9.2) | 271 (73.6) | 63 (17.1) | 27.32 | ＜.001 |
| Verbal response | 3 (6.98) | 29 (67.4) | 11 (25.6) | |||
| Painful response | 7 (12.3) | 37 (64.9) | 13 (22.8) | |||
| Unresponsiveness | 7 (50.0) | 5 (35.7) | 2 (14.3) | |||
| Operation | No | 48 (10.7) | 311 (69.4) | 89 (19.9) | 8.93 | .012 |
| Yes | 3 (8.8) | 31 (91.2) | 0 (0.0) | |||
| Procedure | No | 27 (8.8) | 207 (67.7) | 72 (23.5) | 15.38 | ＜.001 |
| Yes | 24 (13.6) | 135 (76.7) | 17 (9.7) | |||
| DM | No | 25 (8.5) | 212 (72.1) | 57 (19.4) | 3.56 | .168 |
| Yes | 26 (13.8) | 130 (69.2) | 32 (17.0) | |||
| HTN | No | 20 (12.3) | 115 (70.6) | 28 (17.2) | 0.89 | .641 |
| Yes | 31 (9.7) | 227 (71.2) | 61 (19.1) | |||
| Neoplasm | No | 37 (8.9) | 301 (72.2) | 79 (18.9) | 9.57 | .008 |
| Yes | 14 (21.5) | 41 (63.1) | 10 (15.4) | |||
| F-cath | None | 10 (4.5) | 163 (73.4) | 49 (22.1) | 20.33 | ＜.001 |
| Ex-insertion | 15 (12.0) | 88 (70.4) | 22 (17.6) | |||
| ED insertion | 25 (18.7) | 91 (67.9) | 18 (13.4) | |||
| Endo-tracheal tube | None | 31 (7.2) | 319 (74.5) | 78 (18.2) | 44.56 | ＜.001 |
| Ex-insertion | 3 (33.3) | 5 (55.6) | 1 (11.1) | |||
| ED insertion | 16 (36.4) | 18 (40.9) | 10 (22.7) | |||
| Tracheotomy | None | 44 (10.3) | 299 (69.9) | 85 (19.9) | 15.80 | .015 |
| Ex-insertion | 2 (6.1) | 28 (84.8) | 3 (9.1) | |||
| ED insertion | 4 (20.0) | 15 (75.0) | 1 (5.0) | |||
| Ventilator | None | 34 (7.7) | 325 (73.5) | 83 (18.8) | 46.54 | ＜.001 |
| Ex-insertion | 2 (66.7) | 0 (0.0) | 1 (33.3) | |||
| ED insertion | 14 (38.9) | 17 (47.2) | 5 (13.9) | |||
| Central line | None | 25 (6.7) | 276 (73.8) | 73 (19.5) | 26.83 | ＜.001 |
| Ex-insertion | 4 (16.0) | 17 (68.0) | 4 (16.0) | |||
| ED insertion | 21 (25.6) | 49 (59.8) | 12 (14.6) | |||
| Antibiotics | No | 11 (61.2) | 128 (71.5) | 40 (22.4) | 7.63 | .022 |
| Yes | 40 (13.2) | 214 (70.6) | 49 (16.2) | |||
| Type of discharge | Died | 51 (100.0) | 0 (0.0) | 0 (0.0) | 516.74 | ＜.001 |
| Transfer | 0 (0.0) | 214 (72.8) | 80 (27.2) | |||
| Go to home | 0 (0.0) | 127 (94.8) | 7 (5.2) | |||
| Others | 0 (0.0) | 1 (33.3) | 2 (66.7) |
| Variables | Categories | B | SE | Wals | DF | p | OR | 95% CI | |
|---|---|---|---|---|---|---|---|---|---|
| Min | Max | ||||||||
| Gender | Female | Ref | 0.52 | 0.43 | 1 | .513 | 0.71 | 0.26 | 1.97 |
| Male | −0.34 | ||||||||
| Age | 0.35 | 0.28 | 1.67 | 1 | .197 | 1.43 | 0.83 | 2.44 | |
| Hospital LOS | −0.83 | 0.49 | 2.85 | 1 | .092 | 0.44 | 0.17 | 1.14 | |
| G Hospital LOS | −0.23 | 0.32 | 0.54 | 1 | .463 | 0.79 | 0.42 | 1.48 | |
| TRIAGE | 0.07 | 0.50 | 0.02 | 1 | .889 | 1.07 | 0.40 | 2.85 | |
| Mental status (AVPU) | 0.61 | 3 | .894 | ||||||
| Alert | Ref | ||||||||
| Verbal response | −0.45 | 0.86 | 0.27 | 1 | .602 | 0.64 | 0.12 | 3.46 | |
| Painful response | −0.42 | 0.73 | 0.32 | 1 | .570 | 0.66 | 0.16 | 2.77 | |
| Unresponsiveness | 0.37 | 1.49 | 0.06 | 1 | .806 | 1.44 | 0.08 | 26.70 | |
| Antibiotics | No | Ref | |||||||
| Yes | −0.24 | 0.83 | 0.08 | 1 | .771 | 0.79 | 0.15 | 4.00 | |
| Ex-infection | No | Ref | 0.52 | 0.23 | 1 | .633 | 1.28 | 0.46 | 3.56 |
| Yes | 0.25 | ||||||||
| Operation | No | Ref -015 |
|||||||
| Yes | 0.79 | 0.03 | 1 | .853 | 0.86 | 0.18 | 4.08 | ||
| Neoplasm | No | Ref | |||||||
| Yes | 1.74 | 0.59 | 8.75 | 1 | .003 | 5.69 | 1.80 | 17.99 | |
| Foley catheter | No | Ref | |||||||
| Yes | 1.88 | 0.86 | 4.74 | 1 | .030 | 6.54 | 1.21 | 35.48 | |
| Endotracheal tube | No | Ref | |||||||
| Yes | 1.39 | 0.86 | 2.59 | 1 | .107 | 4.01 | 0.74 | 21.70 | |
| Ventilator | No | Ref | |||||||
| Yes | 1.36 | 0.92 | 2.19 | 1 | .139 | 3.91 | 0.64 | 23.83 | |
| Central line | No | Ref | |||||||
| Yes | 1.81 | 0.54 | 11.03 | 1 | .001 | 6.08 | 2.10 | 17.65 | |
| Tracheotomy | No | Ref | |||||||
| Yes | −0.92 | 0.71 | 1.65 | 1 | .199 | 0.40 | 0.10 | 1.62 | |
Table 1
General Characteristics (N=484)
Table 2
Reason for Transfer (N=484)
Table 3
Clinical Characteristics (N=484)
HTN=hypertension; DM=diabetes mellitus; Ex-infection=Infection in the geriatric hospital; PNEU=pneumonia; BSI=blood stream infection; UTI=urinary track infection; ED=emergency department.
Table 4
Clinical Characteristics & Outcome (N=484)
DM=diabetes mellitus; HTN=hypertension; Ex-insertion=inserted in the geriatric hospital; ED-insertion=inserted in the emergency department.
Table 5
Geriatric Hospital Patients Mortality Risk Factor in Visiting Emergency Department (N=484)
OR=odds ratio; CI=confidence intervals; LOS=length of stay; GW=general ward; ICU=intensive care unit.
Table 1
Table 2
Table 3
Table 4
Table 5
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© Korean Academy of Community Health Nursing.
College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
E-mail: office@rcphn.org
© Korean Academy of Community Health Nursing.