A Geriatric Emergency Service for Acutely Ill Elderly Patients: Pattern of Use and Comparison with a Conventional Emergency Department in Italy

Abstract

The current disease-oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). In a secondary analysis of a prospective observational cohort of 200 acutely ill elderly patients presenting to two urban EDs in Ancona, Italy, identifiers and triage, clinical, and social data were collected and the following outcomes considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Death, functional decline, any ED revisit and any hospital admission were also considered as a composite outcome. Odds ratios and 95% confidence intervals (CIs) were calculated. Overall, GED patients were older and frailer than CED patients. The two EDs did not differ in terms of early, late, or frequent ED return or in 6-month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22-0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care.

Influence of nurses' knowledge of ageing and attitudes towards older people on therapeutic interactions in emergency care: A literature review

“…The articles included in this review consisted of seven quantitative studies using cross-sectional surveys or audits [5,6,[12][13][14][15][16], seven qualitative studies that utilised interviews and/or focus groups or observational methods [3,[17][18][19][20][21][22], and two mixed-method studies [23,24]. Not all the studies were conducted exclusively on participants from EDs.…”

“…Not all the studies were conducted exclusively on participants from EDs. Three studies focused on ED nurses or patients [17,18,20], and others were focused on acute-care or general-ward settings [3,5,6,12,14,16,19,[21][22][23][24] or were reviews of education and/or patient files [13,15]. The search results are presented in Table 1.…”

Evaluation of the general characteristics of patients aged 85 years and above admitted to a university hospital emergency department

“…In the United States, Canada, and the United Kingdom, new geriatric EDs have opened, and doctors and nurses specializing in geriatrics have started to work in EDs (4,5).…”

Delirium

“…21 Por estar relacionado a causas iatrogênicas e ao processo de cuidado atendimento, defende-se a incidência de delirium como marcador para a qualidade de atendimento hospitalar e promove oportunidade para melhorias no atendimento à população idosa. 24 …”