Aims: Early recognition of clinical deterioration is vital to reduce morbidity and mortality in hospitalised patients. Although patient or caregiver concern has been associated with adverse outcomes in paediatric and general adult populations, evidence in older adults is limited. This study examined the relationship between patient or caregiver concern for clinical deterioration and critical illness in hospitalised older adult patients.
Methods: We conducted a retrospective observational study inclusive of patients aged 65 years and older presenting to the Emergency Department (ED) across Monash Health campuses between June 2024 and May 2025, including those discharged and admitted. Patient or caregiver concern for clinical deterioration was assessed using the question, “Are you worried you/they are getting worse?”, documented during routine vital sign assessment in the ED and inpatient wards. Demographic and clinical data were extracted from hospital databases. Associations with intensive care unit (ICU) admission and in-hospital mortality were examined using univariable and multivariable logistic regression adjusting for prespecified covariates.
Results: Among 32,962 eligible presentations, 4,242 patients had documented patient or caregiver concern for clinical deterioration. Positive concern was independently associated with increased odds of ICU admission (adjusted OR [aOR] 1.21, 95% CI 1.02–1.43) and death during admission (aOR 1.44, 95% CI 1.23–1.69). Older age was associated with lower odds of ICU admission (aOR 0.93, 95% CI 0.92–0.94) but higher odds of death (aOR 1.03, 95% CI 1.03–1.04).
Conclusions: Patient or caregiver concern for clinical deterioration was independently associated with ICU admission and in-hospital mortality in hospitalised older adults.