Aged :: Listen to the elderly, they know how they feel

Self-rated health is a strong predictor of functional decline and mortality for elderly people presenting to a hospital emergency department, according to a new study published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.

Dr Daniel Wong (from the Prince of Wales Hospital), Dr Reginald Wong (from the University of New South Wales), and Dr Gideon Caplan (from the Prince of Wales Hospital and School of Public Health and Community Medicine at the University of New South Wales) studied over 700 elderly people who were sent home after receiving treatment at an emergency department.

On enrolment in the study, patients were asked the self-rated health (SRH) question, ?In general, would you say your health is excellent, very good, good, fair or poor??

Phone interviews were then conducted at 3, 6, 12 and 18 months, and how well they were able to conduct activities of daily living was assessed.

In recent years, several studies have assessed SRH in well elderly people who were dwelling in the community.

This new research published by Dr Wong and his colleagues is unique in its assessment of SRH for predicting functional decline and mortality in the acutely unwell older person, where one might have thought that at the time of an emergency department presentation the SRH would drop dramatically.

The five most common reasons for emergency department presentations by elderly people were falls (23%), syncope (fainting)(16%), gastrointestinal (12%), cardiac (10%) and respiratory (7%) complaints.

SRH is believed to be the summation of a wide range of biopsychosocial determinants of health, some of which might not be medically detectable or are not included in the conventional medical exam.

SRH has even been shown to be more sensitive than physician-based, objective ratings of health and conventional clinical risk factors such as smoking and diabetes in evaluating physical, mental, and social well-being.

It might be expected that acute conditions of the unwell elderly presenting to the ED would bias their overall assessment of health and therefore diminish the ability of SRH to predict adverse outcomes in this setting, but this was not found to be the case.

This study shows that the predictive value of SRH for mortality and functional decline is equally valid for the unwell elderly as for the well community dwellers.

?We believe that the nature of the SRH question prompts the individual to evaluate their health globally, beyond the immediate condition responsible for their presentation to the ED,? the researchers say.

?It serves as a reminder that there are limitations to what can be achieved through objective measures of health and underlines the importance of listening to our patients.

?We believe that it would be a simple and valuable clinical assessment tool to identify high-risk individuals who might benefit from further interventions aimed at preventing such adverse outcomes, such as comprehensive geriatric assessment aimed at delaying these outcomes.?

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