Abstract
Abstract
Background
“Failure to cope at home” (FTC) is a non-specific label without a specific definition. Its French equivalent, “maintien à domicile difficile”, is frequently used in emergency departments (ED), but the clinical meaning and outcomes associated with this label remain poorly described in this context. This term is sometimes used as the main diagnosis of care and could masking a medical condition. This study aims to assess the clinical and social characteristics of patients presenting with FTC term in EDs.
Methods
A retrospective study was conducted at Tours and Orléans University Hospitals Center from January 1 to December 31, 2022. Patients aged 18 or older with a documented FTC label were included. We described demographics, comorbidities, frailty burden, ED characteristics, acute medical conditions, hospitalisations, post-discharge outcomes and mortality.
Results
A total of 667 emergency admissions (EA) involving 614 patients were analysed. The population was predominantly older, with a mean age of 80.9 ± 11.2 years, and 348 patients (57.2%) were female. Neurocognitive disorders, psychiatric illness, and stroke were the most frequent medical histories. Over half of the patients lived alone (55.8%), and 91.7% resided in their own homes. Hospitalisation occurred after 485 emergency admission (71.0%). Only 6.4% (n = 40) of ED admissions had no medical problems other than the FTC label. Overall, 348 EA (54.5%) resulted in return home at hospital discharge, and the weighted mean hospital length of stay was 16.7 ± 16.6 days. In-hospital mortality rate at discharge was 8.8% (n = 60), while 30-day and 90-day mortality were 10.9% (n = 71) and 18.6% (n = 119), respectively.
Conclusions
The FTC label identifies a complex and vulnerable population. Notably, acute medical conditions predominated, and cases with only social or functional presentations were rare. This suggest that the FTC label should not be interpreted as indicative of purely social admission. Instead, a syndromic approach integrating acute medical assessment, functional evaluation, caregiver burden, and discharge feasibility may better address the needs of these specific population.
Trial registration
This study was conducted following the French reglementation and was approved by a local ethics committee (reference number: CERO 2603-03). Study was register on https://health-data-hub.fr with reference F20230606113524 (6 June 2023).