INTRODUCTION: We investigated the degree of functional decline and loss of independence among older adults presenting to the emergency department (ED) with serious infection and to estimate 90-day case fatality. METHODS: Consecutive patients 70 years or older (n = 50) presenting to the ED with potentially serious infection were identified using an automated case-identification algorithm. Fifty age- and sex-matched controls were recruited from a registry of community volunteers. Functional and residential statuses were ascertained at hospital admission, discharge, and 90 days. Details regarding patients' comorbidities, acute illness, and diagnostic evaluation were collected along with 90-day survival. RESULTS: Older adults with suspected sepsis had substantial 90-day mortality (32.0%). Baseline functional impairment was more severe among cases than among control subjects, although activities of daily living and instrumental activities of daily living deficits did not predict outcome. Hospital admission was also not uniformly associated with deterioration in either activities of daily living or instrumental activities of daily living performance. Patients admitted from home were at no greater risk of functional decline than were those admitted from care facilities. No enrolled case enjoyed an increase in residential independence after discharge; of the 28 who were independent upon admission, 19 survived to 90 days, and 8 of the 19 required visiting assistance or were in a care facility. CONCLUSIONS: Older adults presenting to the ED with potentially serious infection have significant 90-day mortality. Although functional status does not consistently deteriorate in survivors, there seems to be considerable risk in the short-term for loss of residential independence.
INTRODUCTION: We investigated the degree of functional decline and loss of independence among older adults presenting to the emergency department (ED) with serious infection and to estimate 90-day case fatality. METHODS: Consecutive patients 70 years or older (n = 50) presenting to the ED with potentially serious infection were identified using an automated case-identification algorithm. Fifty age- and sex-matched controls were recruited from a registry of community volunteers. Functional and residential statuses were ascertained at hospital admission, discharge, and 90 days. Details regarding patients' comorbidities, acute illness, and diagnostic evaluation were collected along with 90-day survival. RESULTS: Older adults with suspected sepsis had substantial 90-day mortality (32.0%). Baseline functional impairment was more severe among cases than among control subjects, although activities of daily living and instrumental activities of daily living deficits did not predict outcome. Hospital admission was also not uniformly associated with deterioration in either activities of daily living or instrumental activities of daily living performance. Patients admitted from home were at no greater risk of functional decline than were those admitted from care facilities. No enrolled case enjoyed an increase in residential independence after discharge; of the 28 who were independent upon admission, 19 survived to 90 days, and 8 of the 19 required visiting assistance or were in a care facility. CONCLUSIONS: Older adults presenting to the ED with potentially serious infection have significant 90-day mortality. Although functional status does not consistently deteriorate in survivors, there seems to be considerable risk in the short-term for loss of residential independence.