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Certain Symptoms in NH Residents Predict Better Emergency Department Outcomes


March 11, 2021

How a nursing home patient will react to an emergency department transfer can be predicted by comorbidity and functional abilities, yet challenged by acute conditions and associated stress, according to a study published in The Journal of Nutrition, Health & Aging.  

“Nursing home residents’ resilience is key to estimate the appropriateness of an emergency department transfer and should facilitate advance care planning regarding nursing home resident hospitalizations,” researchers wrote. 

The observational multicenter study described symptom trajectories of 751 nursing home residents in France transferred to 17 different emergency departments. The 4-week observation period was nonconsecutive, with researchers tracking emergency department transfers over a single week each season.  

The study identified five patterns of symptom trajectory evolution in nursing home residents after they were transferred to the emergency department: (1) 190 participants presented with confusion and increasing fatigue; (2) 212 presented with highly prevalent but declining pain; (3) 158 presented with peaking pain, rising confusion and fatigue, and high but stable agitation; (4) 144 presented with highly prevalent but declining dyspnea, rising then declining fever, increasing confusion, and high, fluctuating levels of fatigue; and (5) 47 presented with highly prevalent but declining fever, rising then declining dyspnea, high but stable levels of fatigue and pain, and low but stable confusion. 

“Symptom alleviation in nursing home residents transferred to [the] emergency department was better achieved in those with pain, fever, or dyspnea,” researchers wrote, “rather than in those with confusion, agitation, and fatigue.” 

Jolynn Tumolo

Reference:

Guion V, de Souto Barreto P, Rolland Y. Trajectories of Symptoms in Nursing Home Residents after a Transfer to the Emergency Department. J Nutr Health Aging. 2021;25(3):318-324. doi:10.1007/s12603-020-1476-3

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