Pathways of Elderly People Aged 75 and Over Hospitalized in the Geriatric Department of the University Hospital of Bordeaux

BACKGROUND: Studies have shown that extended stays in Emergency Departments (ED) are detrimental to the health of elderly people. We aimed to compare Unscheduled Direct Admission (UDA) with admission after entry through the ED (EDA) for patients aged 75 and over, hospitalized in geriatrics at the Bordeaux University Hospital, between 2017 and 2019. METHODS: The study data were extracted from the hospital discharge database and the hospital information system. We compared in-hospital mortality and the modalities of discharge among UDA and EDA patients. A Cox proportional hazard model and a multinomial logistic regression were used to explore in-hospital mortality and the modalities of discharge, respectively. Missing data were handled by multiple imputation procedures. RESULTS: Between 2017 and 2019, 2,416 patients aged 75 and over were admitted for unscheduled hospitalization to geriatrics, including 669 (28%) UDA and 1,747 (72%) EDA. The UDA patients were younger (86.9 _vs_ 87.7 years old, p=0.002), had fewer acute diseases (43%_ vs_ 79%) and neurological diseases than EDA (24% _vs_ 30%, p=0.003). They also had a shorter length of stay on average (14.3 vs 15.9, p=0.0004). The UDA patients who were discharged alive more often returned home (83% _vs_ 75% for EDA), while EDA patients were more often transferred to rehabilitation (17% _vs_ 10% for UDA). The UDA patients, hospitalized for hematological diseases, were less likely to be transferred to rehabilitation (Odds Ratio: 0.10; 95% Confidence Interval [0.01-0.88]). The adjusted risk of death was not significantly different in UDA patients compared to EDA patients (HR = 1.00 [0.54;1.85]). CONCLUSIONS: The mortality and discharge rates did not differ between UDA and EDA patients. However, the length of hospital stay was longer for patients admitted through the Emergency Department. The UDA should be the admission pathway for elderly patients to relieve congestion in Emergency Departments.