Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

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Background:For the elderly population living at home, the implementation of professional services tends tomitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation,home services could also be associated to different healthcare pathways. For elderly patients, EmergencyDepartments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worsthospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping athome without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDsassisted by home services. Our aim was to compare among elderly patients visiting ED those assisted byprofessional home services to those who do not in terms of emergency resources’use and patients’outcome.Methods:A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period onMarch 2016.Consecutive patients living at home aged≥80 years were included. The primary objective was to assessthe risk of mortality for patients assisted by professional home services vs. those who were not. Secondaryobjectives included admission rate and specific admission rate for“having difficulties coping at home”. The primaryendpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the associationbetween professional home services and the primary endpoint. Multi variables logistic regressions were performedto assess secondary endpoints.Results : One thousand one hundred sixty-eight patients were included, median age 86(83–89) years old,32% wereassisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI[0.68–2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65–1.30]). Assisted patients had a lower risk of beingadmitted for“having difficulties coping at home”(OR = 0.59;95%CI [0.38–0.92])