Published Work by AGEM Member: Ari Friedman, MD, PhD
Assistant Professor, Emergency Medicine, Perelman School of Medicine
The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations
Physical frailty, cognitive impairment, and their interaction (deemed "cognitive frailty") impair the lives of many older adults and make them vulnerable to acute health shocks leading to further morbidity and risk of mortality. In this work, led by Brian Buta and Qian-Li Xue, we study how baseline cognitive frailty is associated with subsequent hospitalizations. We demonstrates that hospitalizations are common at baseline, and more so in patients with cognitive impairment, frailty, or both. We then examine the relative impact of cognition and frailty on ED-initiated vs directly admitted hospitalizations in a changing health system where many more hospitalizations now come through the ED. Patients with cognitive frailty had the highest risk of ED-initiated hospitalization, with nonspecific symptoms being the most prevalent admission diagnosis category. Our study demonstrates that the ED forms a central site of care for older patients with cognitive impairment, frailty, or both. Patients with cognitive frailty are at particularly high risk of ED-initiated hospitalization, and require additional attention to ensuring communication to the patient and their care partner when applicable, in order to achieve an accurate diagnosis and a management in line with patient goals of care.
Ari B. Friedman is an Assistant Professor of Emergency Medicine at the University of Pennsylvania, holds a secondary appointment in the Department of Medical Ethics and Health Policy, is Core Faculty at the Center for Emergency Care Policy and Research, and is a Senior Fellow of the Leonard Davis Institute of Health Economics. His research investigates the unscheduled care system (primary care clinics, urgent care and retail clinics, telemedicine, and emergency departments)'s impact on access to care, finances, and health outcomes particularly for older adults.