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Aging and Disease    2015, Vol. 6 Issue (3) : 188-195     DOI: 10.14336/AD.2014.0706
Original Article |
Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits
Anupam Chandra1(),Sarah J Crane1,Ericka E Tung1,Gregory J Hanson1,Frederick North1,Stephen S Cha2,Paul Y Takahashi1
1Division of Primary Care Internal Medicine, Department of Health Sciences Research; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2 Department of Health Sciences Research; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract  

There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year.

Keywords emergency department      geriatric screening      hospitalization     
Just Accepted Date: 06 February 2015   Issue Date: 22 May 2015
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Anupam Chandra
Sarah J Crane
Ericka E Tung
Gregory J Hanson
Frederick North
Stephen S Cha
Paul Y Takahashi
Cite this article:   
Anupam Chandra,Sarah J Crane,Ericka E Tung, et al. Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits[J]. A&D, 2015, 6(3): 188-195.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2014.0706     OR     http://www.aginganddisease.org/EN/Y2015/V6/I3/188
Variable Overall (N=7738)
Age, y mean (± SD) 76.2 (± 7.68)
Female, n (%) 4395 (57)
Male, n (%) 3343 (43)
MAGE Questions, n (%)
History of weight loss in last 3 months 598 (8)
History of 2 or more falls in past year 962 (12)
History of being hurt in fall in past year 930 (12)
Difficulty with vision 1526 (20)
Difficulty with hearing 3105 (41)
History of being sad or depressed 864 (11)
History of unintended urinary leakage 3147 (41)
History of urinary leakage severe enough to seek treatment 626 (9)
Rate your health compared to others in your age group
Better 3484 (45)
Same 3487 (45)
Worse 432 (6)
Missing 335 (4)
Table 1  Demographics and results of the MAGE survey
ED visit or Hospitalization within 1 year
Variable No ED visit/Hospitalization ED visit/Hospitalization within 1 year OR & 95% CI
(N=5064) (N=2674) OR Lower Upper P value
Age, y, mean (± SD) 75.15 (± 7.39) 78.05 (± 7.87) 1.05 1.04 1.06 <.0001
Male, n (%) 2175 (43) 1168 (44) 1.03 0.94 1.13 0.5375
MAGE survey, n (%)
History of weight loss in last 3 months 335 (7) 263 (10) 1.54 1.30 1.82 <.0001
History of 2 or more falls in past year 481 (10) 481 (18) 2.09 1.83 2.40 <.0001
History of being hurt in a fall in past year 528 (11) 402 (15) 1.52 1.32 1.74 <.0001
History of difficulty with vision 913 (18) 613 (23) 1.35 1.21 1.52 <.0001
History of difficulty with hearing 1935 (39) 1170 (44) 1.25 1.14 1.38 <.0001
History of being sad or depressed 469 (9) 395 (15) 1.72 1.49 1.98 <.0001
History of unintended urinary leakage 1994 (40) 1153 (44) 1.17 1.07 1.29 0.0011
History of urinary leakage severe enough to see treatment 360 (7) 266 (11) 1.45 1.23 1.71 <.0001
Rate your health compared to others: Worse 192 (4) 240 (9) 2.55 2.10 3.10 <.0001
Table 2  Univariate predictors of the combined outcome of ED visit or hospital admission within 1 year
From single run From simulations
95% CI
Standard Parameter Estimate OR Lower Upper P value Estimate (Average) OR Score
Intercept -1.367 <.0001
Male 0.080 1.08 0.97 1.21 0.1483 0.085 1.09
Age 70-74 0.287 1.33 1.14 1.56 0.0004 0.284 1.33 1.000
Age 75-79 0.608 1.84 1.56 2.16 <.0001 0.601 1.83 2.000
Age 80 or more 0.826 2.29 1.98 2.64 <.0001 0.822 2.28 2.000
History of weight loss in last 3 months 0.210 1.23 1.02 1.49 0.0286 0.217 1.24 1.000
History of 2 or more falls 0.487 1.63 1.38 1.93 <.0001 0.486 1.63 2.000
History of being hurt in a fall 0.105 1.11 0.94 1.32 0.2244 0.106 1.11
History of difficulty with vision 0.075 1.08 0.94 1.23 0.2681 0.073 1.08
History of difficulty with hearing 0.070 1.07 0.96 1.20 0.2102 0.068 1.07
History of being sad or depressed 0.272 1.31 1.11 1.55 0.0011 0.273 1.31 1.000
History of unintended urinary leakage -0.053 0.95 0.85 1.06 0.3689 -0.052 0.95
History of urinary leakage severe enough to seek treatment 0.149 1.16 0.96 1.41 0.1348 0.146 1.16
Worse self-rated health 0.748 2.11 1.70 2.63 <.0001 0.760 2.14 2.000
Table 3  Multivariable model for predictors of ED visit or hospitalization within 1 year of completing the MAGE
MAGE Score
Variable 0 1 2 3+ P value
(N=1391) (N=1403) (N=2881) (N=1565)
ED visits, n (%) 216 (16) 283 (20) 895 (31) 695 (44) <.001
Hospitalization, n (%) 170 (12) 214 (15) 684 (24) 562 (36) <.001
ED visit/hospitalization, n (%) 289 (21) 358 (26) 1043 (36) 784 (50) <.001
Table 4  Results of the score system from the logistic model to predict ED visits and/or hospitalizationswithin1 year of completing MAGE
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