Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey

Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital - A single-center registry

Aim:

Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.

Methods:

A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018–January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.

Results:

Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; P value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).

Conlusion:

Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.

Elderly patients presenting to a rural hospital emergency department in inland Croatia - A retrospective study

BACKGROUND

Emergency departments are faced with a high influx of patients presenting for various complaints. The aim of the present study was to assess the basic characteristics of elderly patients presenting to a rural hospital emergency department in inland Croatia in 2017.

METHODS

Retrospective data collected from the Hospital Information System and by analysis of medical records on patients presenting to emergency department in 2017 were used in the study.

RESULTS

Study results indicated that a lower proportion of elderly individuals aged 65-74 were hospitalized following emergency department workup. A statistically significantly higher proportion of patients older than 74 years was presented to ED due to various discomforts and diseases (ICD-10 group I; χ2 = 324.85; p < 0.01) than due to cardiorespiratory diseases and acute abdomen (χ2 = 285.04; p < 0.01).

CONCLUSION

Our findings highlight the need for a complex approach in care for elderly people, given that they are a fragile population with multiple comorbidities, chronic diseases, atypical symptoms, and often with cognitive and functional impairments.

Low Back Pain in a Nova Scotian Emergency Department: Prevalence and Patient Characteristics in the Older Adult Patient Population

Low back pain is a major cause of disability in older adults, and results in many emergency department visits each year. Characteristics of the older back pain population are largely unknown. We conducted a retrospective study to examine the prevalence and patient characteristics for older (≥ 65 years of age) and younger (16-64 years of age) adults presenting with back pain. Study objectives were to describe the characteristics of older adults with back pain presenting to an emergency department and to identify age-group based differences in management. Older adults were most commonly diagnosed with non-specific low back pain (49%). For older adults with this diagnosis, the length of stay was 2.1 times longer (p < 0.001), and odds of being admitted to the hospital were 5.1 times higher (p < 0.001) than for younger adults. Patterns of management are different for younger and older adults with low back pain; this information can be used to direct future resource planning.

Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey

Objective: In this study, we aimed: (1) to evaluate the presenting symptoms of older emergency department (ED) patients within a 12-month period, (2) to compare the differences in presenting symptoms between three age groups, and (3) to evaluate the seasonal variations in the presenting symptoms. Methods: This retrospective single-centered observational study was conducted at the ED of a university hospital in older ED patients with yellow and red triage code. Consecutive patients aged 65 and older admitted to ED in the study period were included in the study. Results: In our study, 14.0% of all ED admissions were patients aged 65 and older. The mean age of 10,692 patients was 75.3 ± 7.3 years, and 49.2% of them were male. The most common presenting symptoms to ED were dyspnea (18.5%), abdominal pain (12.4%), and chest pain (8.3%). Whereas 6,352 (59.4%) patients had been discharged from the ED (to home), 4,305 (40.3%) were hospitalized. Falls became the third rank presenting symptom in patients aged 85 and older. The hospital admission rate increased from 35% to 53% by age, and the in-hospital mortality rate of patients aged 85 and older was higher than that of the other age groups (p < 0.001). Conclusion: ED physicians should be aware of the common medical problems and life-threatening conditions of older patients. Morbidity and mortality rates increase by age and those patients may need different management strategies and an increased number of resources.

Emergency Department Visits and Disease Burden Attributable to Ambulatory Care Sensitive Conditions in Elderly Adults

Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50-5.58); UTI (aOR: 4.44, 95% CI 3.97-4.98); sepsis (aOR: 3.54, 95% CI 3.06-4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63-3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.

Age and sex differences in emergency department visits of nursing home residents: a systematic review

Background

Nursing home residents (NHRs) are often transferred to emergency departments (EDs). A great proportion of ED visits is considered inappropriate. There is evidence that male NHRs are more often hospitalised, but this is less clear for ED visits. It is unclear, which influence age has on ED visits. We aimed to study the epidemiology of ED visits in NHRs focusing on age- and sex-specific differences.

Methods

A systematic review was carried out based on articles found in MEDLINE (via PubMed), CINAHL and Scopus. Articles published on or before Aug 31, 2017 were eligible. Two reviewers independently identified articles for inclusion. The quality of studies was assessed by the Joanna Briggs Institute critical appraisal tool for prevalence studies.

Results

Out of 1192 references, we found seven studies meeting our inclusion criteria. Six studies were conducted in the USA or Canada. Overall, 29–62% of NHRs had at least one ED visit over the course of 1 year. Most studies assessing the influence of sex found that male residents visited EDs more frequently. All but one of the five studies with multivariable analyses reported a statistically significant positive association (with odds or rate ratios of 1.05–1.38). All studies assessed the influence of age. There was no clear pattern with some studies showing no association between ED visits and age and other studies reporting decreasing ED visits with increasing age or increasing proportions followed by a decrease in the highest age group. Studies used 85+ or 86+ years as the highest age category. Hospital admission rate ranged from 36.4 to 48.7%. There was no study reporting stratified analyses by age and sex. Only one study reported main diagnoses leading to ED visits stratified by sex.

Conclusion

Male NHRs visit EDs more often than females, but there is no evidence on reasons. The association with age is unclear. Any future study on acute care of NHRs should assess the influence of age and sex. These studies should include large sample sizes to provide a more differentiated age categorisation.

Trial registration

PROSPERO CRD42017074845.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0848-6) contains supplementary material, which is available to authorized users.

Chief Complaints of Elderly Individuals on Presentation to Emergency Department: A Retrospective Analysis of South Korean National Data 2014

PURPOSE

We aimed to assess the chief complaints (CCs) of elderly individuals on presentation to the emergency department (ED) according to gender, age, and disease-related and injury-related visits.

METHODS

The 2014 registry database of the National Emergency Department Information System in South Korea, which included data on 908,761 ED visits by individuals aged 65 years and over, was reviewed.

RESULTS

We found that 80.7% ED visits were related to disease, whereas the remaining visits were related to injury. The most common CCs presented by elderly male and female individuals with disease-related visits were dyspnea and dizziness, respectively. The 10 most common CCs accounted for 45.5% and 49.2% of the total disease-related visits for male and female individuals, respectively. The most common CC in male and female individuals with injury-related visits was headache and hip pain, respectively. The CC rank showed minimal variance among the different age groups, but a difference was observed between male and female individuals. The most common mechanism of injury in elderly male and female individuals was slipping, wherein females showed a higher occurrence rate than their male counterparts.

CONCLUSIONS

These findings can be used to establish an ED training curriculum for nursing students and ED nurses, particularly for ED triage in the elderly.

The ED use and non-urgent visits of elderly patients

Objective

To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits.

Methods

This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively.

Results

A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1–17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units.

Conclusion

The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

BACKGROUND

Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program.

METHODS

RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.

RESULTS

In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007].

CONCLUSION

The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.