Association between social isolation and outpatient follow-up in older adults following emergency department discharge. (March 2021)

• Record Type: Journal Article
• Authors: Cayenne, Nia A.; Jacobsohn, Gwen Costa; Jones, Courtney M.C.; DuGoff, Eva H.; Cochran, Amy L.; Caprio, Thomas V.; Cushman, Jeremy T.; Green, Rebecca K.; Kind, Amy J.H.; Lohmeier, Michael; Mi, Ranran; Shah, Manish N.
• Is Part Of: Archives of gerontology and geriatrics. Volume 93(2021)
• Publication Date: 2021-03
• Subjects: Social isolation -- Outpatient follow-up -- Emergency medicine -- Care transitions -- Primary care; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2020.104298
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: Socially-isolated older adults had significantly less in-person follow-up with outpatient providers within the 7 days following ED discharge. Social isolation did not predict outpatient follow-up at 30 days post ED discharge. Older adults with moderate to severe depression were 2.5 times more likely to follow-up within 7 days of ED discharge. Those who live alone had significantly less in-person follow-up within 7 days while those identifying as a race other than white had higher rates. Older adults with a higher number of chronic conditions were more likely to follow up within 30 days. Abstract: Objectives: Follow-up with outpatient clinicians after discharge from the emergency department (ED) reduces adverse outcomes among older adults, but rates are suboptimal. Social isolation, a common factor associated with poor health outcomes, may help explain these low rates. This study evaluates social isolation as a predictor of outpatient follow-up after discharge from the ED. Materials and methods: This cohort study uses the control group from a randomized-controlled trial investigating a community paramedic-delivered Care Transitions Intervention with older patients (age≥60 years) at three EDs in mid-sized cities. Social Isolation scores were measured at baseline using the PROMIS 4-item social isolation questionnaire, grouped into tertiles for analysis. Chart abstraction was conducted to identify follow-up with outpatient primary or specialty healthcare providers and method of contact within 7 and 30 days of discharge. Results: Of 642 patients, highly socially-isolated adults reported significantly worse overall health, as well as increased anxiety, depressive symptoms, functional limitations, and co-morbid conditions compared to those less socially-isolated ( p <0.01). We found no effect of social isolation on 30-day follow-up. Patients with high social isolation, however, were 37% less likely to follow-up with a provider in-person within 7 days of ED discharge compared to low social isolation (OR:0.63, 95% CI:0.42–0.96). Conclusion: This study adds to our understanding of how and when socially-isolated older adults seek outpatient care following ED discharge. Increased social isolation was not significantly associated with all-contact follow-up rates after ED discharge. However, patients reporting higher social isolation had lower rates of in-person follow-up in the week following ED discharge.