Correlates of the Veterans Visiting Emergency Departments in Taiwan: A Comparison Before and After the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. METHODS: This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. RESULTS: Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). CONCLUSIONS: The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care-sensitive conditions.

Geriatric syndromes predict mortality of people aged 75+ years in the observation room of emergency department: Towards function-centric emergency medicine.

BACKGROUND: Aging is a complex process involving functional decline, reduced physiological reserve, increased multimorbidity, and impaired homeostasis, all of which collectively generate various health risks for older adults. To predict short-term mortality of non-critical older patients in the observation room of the emergency department (ED) based on function-centric approach instead of disease-centric one. METHODS: We conducted a prospective study enrolling 831 patients aged 75 years and older between 2018 and 2020. Comprehensive geriatric assessment was performed on all patients, and the results were integrated into the care planning process. RESULTS: In total 831 patients (mean age: 84.8 ± 5.8 years) were enrolled and the post-discharge mortality rate was 3.3% (28 deaths) after 3 months, and 5.4% (45 deaths) after 6 months. The independent predictors of 3-month mortality were malnutrition (adjusted odds ratio [OR], 4.77; p < 0.05), incontinence (adjusted OR, 2.58; p < 0.05) and multimorbidity (adjusted OR, 1.51; p < 0.001). For 6-month mortality, malnutrition (adjusted OR, 4.20; p < 0.01), multimorbidity (adjusted OR, 1.40; p < 0.001) and activities of daily living (adjusted OR, 0.99; p < 0.05) were all independent predictors. CONCLUSION: Although ED aims to treat acute and life-threatening conditions, older persons with geriatric syndromes are also at a substantially high risk of adverse outcomes, even mortality. Transitioning of the ED from disease-centric to function-centric services is important for responding to the changing health care needs of super-aged societies.