Frequency and factors related to very early return of older persons to the emergency department: A separate analysis of men and women (EDEN-26 study).

OBJECTIVES

Discharge from acute care assumes adequate medical and social conditions. Very early return to the emergency department (i.e. within 72 h) may reflect a failure to ensure a safe discharge. Older persons are particularly vulnerable, yet sex-related disparities remain underexplored. We assessed the incidence and sex-specific predictors of very early returns to the emergency department.

METHODS

We analyzed 23,962 consecutive individuals aged 65 years or more from the multicenter Spanish EDEN registry, including patients discharged home alive from 52 emergency departments, with post-discharge follow-up. The outcome was any emergency department return within 72 h after discharge either from the emergency department or following hospitalization. Candidate predictors included age, living arrangements, comorbidity, functional status, walking ability, previous falls, and prior diagnoses of depression, dementia, or delirium. Multivariable logistic regression models were stratified by sex, adjusted for all candidate predictors, and included interaction terms to assess sex-specific effects.

RESULTS

The overall incidence of very early emergency department return was 6.6% (7.1% in men and 6.2% in women). In men, comorbidity was independently associated with return. In women, comorbidity, functional dependence, previous falls, and depression were independent predictors. Significant sex-by-predictor interactions indicated a stronger association for previous falls in women in the overall cohort, for depression in women discharged directly from the emergency department, and for prior delirium in women discharged after hospitalization. Male sex was independently associated with a higher adjusted risk of very early emergency department return (adjusted odds ratio 1.12).

CONCLUSIONS

Predictors of very early emergency department return differ by sex in older persons. Previous falls and depression have a stronger impact in women, while male sex is independently associated with a higher baseline risk. Sex-sensitive discharge planning may help reduce avoidable early revisits and improve transitional care.