Relationship between Comorbidity, Polypharmacy, Physiological Deterioration Severity and Emergency Department Discharge Destination in Elderly Patients

Abstract

           The number of elderly patients visited emergency department is increasing every year. The patients have complex and severe symptom of illness that could increase the risk of disability and death. Therefore, assessing the patient’s condition is important. This research aimed to identify the correlation between the emergency department discharge destination and the physiological deterioration severity, polypharmacy and comorbidity. The study design was a descriptive correlational study. The study sample consisted of 300 patients aged 65 years and over visited the emergency department of a hospital in central region of Thailand. Data were collected using the comorbidity evaluation form, polypharmacy evaluation form, modified early warning score (MEWS) and the emergency department discharge evaluation form. Data were analyzed using the descriptive statistics and Spearman’s rank correlation.

           The results showed that subjects’ age ranged from 65 to 99 years (X ̅ = 77.4, S.D. = 7.7). Of these, 53.7% were female, 98.7% had comorbidity, 78.6% had hypertension, 52.3% used more than 5 drugs, 40.4% had moderate to severe MEWS scores at first visit, 54.7% were discharged from the emergency department to general ward and 2% admitted in the intensive care unit. The moderate positive correlation was found between the subjects’ physiological deterioration severity and their emergency department discharge (r = 0.55, p < .001), whereas low positive correlations were found between the polypharmacy, comorbidity and emergency department discharge (r = 0.34, p < 0.001, r = 0.35, p < 0.001, respectively).
           Keywords: Comorbidity, Polypharmacy, Elderly patient, Physiological deterioration severity