Study objectives: We sought to describe older patients’ health-related quality of life during a 4-month period surrounding a visit to the emergency department and to identify factors associated with less recovery. Methods: We prospectively studied 983 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Eighty percent of the patients were African American, and 63% were women. The primary outcome measures were the Katz Index of Activities of Daily Living and revised validated questions from the Medical Outcomes Study Health Survey at 1 month before the ED visit, the time of the ED visit, and 2-week and 3-month follow-up periods. Results: In general, patients worsened markedly during the illness and then improved, although not to baseline levels. After adjustment for demographic and social factors, the most consistently powerful predictors of poor recovery were more deficiencies in activities of daily living at baseline, reports of needing more help with everyday tasks, increasing Charlson Comorbidity Index scores, and requiring a proxy for the initial survey. Conclusion: Emergency physicians and primary care physicians should consider inquiring about functional status and the adequacy of help at home in addition to comorbid conditions for their acutely ill older patients to target those at greatest risk for poor recovery. Future work needs to test interventions that may improve the health-related quality of life of these vulnerable patients. [Chin MH, Jin L, Karrison TG, Mulliken R, Hayley DC, Walter J, Miller A, Friedmann PD: Older patients’ health-related quality of life around an episode of emergency illness. Ann Emerg Med November 1999;34:595-603.]