Functional decline in older adults with suspected pneumonia at emergency department presentation

Acute illness causes physical function decline and mortality in older adults (age ≥ 65 years).1, 2 Older adults admitted or discharged from the emergency department (ED)1, 2 are particularly at risk for functional decline and some never return to their pre-illness baseline.2 Functional status determines whether a person can manage their new illness or injury at home and therefore impacts disposition decisions.The Geriatric ED Guidelines,3 Geriatric ED Accreditation, and growth of geriatric EDs has placed a new focus on identifying older adults at risk for functional decline during ED visits. Although a recent umbrella review demonstrated low evidence of benefit of ED interventions to prevent or reduce functional decline in older adults, these previous efforts focus on the long-term trajectory of functional status after acute illness, trauma, or heterogenous patient groups prior to Geriatric ED Accreditation. There is limited understanding of acute functional impairment due to medical illness in older adults at the point of ED presentation since the advent of Geriatric ED Guidelines. The purpose of this study was to describe the prevalence of acute decline in ability to perform activities of daily living (ADL) in older adults presenting to the ED with suspected pneumonia.