Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital

Abstract

BackgroundAging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65–84 years during this period and to investigate the evolution of these comparisons over time.MethodsData considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated.ResultsBetween 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65–84 years. Compared to patients aged 65–84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010.ConclusionsOldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.

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

“…Kennelly et al reported the rate of readmission within 1 month to be 13% and the rate of readmission within 1 year to be 50% (29). Vilpert et al stated the rate of readmission to the ED of patients aged 85 years and above within 1 month as being 8% (12). Male patients according to one study (17) and female patients according to another study (22) were more frequently readmitted.…”

“…In our study, patients aged 85 years and above were admitted to our ED because of infection (pneumonia, lower respiratory tract, urine, upper respiratory tract, and soft tissue infections) (13.3%), musculoskeletal system problems (soft tissue traumas, crashes, sprains, fractures, dislocations) (11.8%), gastrointestinal system problems (nausea, vomiting, constipation, diarrhea, dyspeptic complaints) (11.7%), pain (most commonly abdominal pain, suprapubic pain, and headache) (10.9%), and falls (9.9%). Vilpert et al reported that trauma related to falling was the first most common and cardiovascular problems were the second most common cause of admission in patients aged 85 years or over (12). Again, studies have indicated that the rate of falling among patients aged 80 years and above is 50%, major injury occurs in 5%-10% of these falls, hospitalization is required in 5% of patients, and the mortality rate is 5% (2).…”

An observational, retrospective study of the length of stay, and its influencing factors, among elderly patients at the Emergency Department

“…The most recent published article calculated a LOS of 6.5 hours for patients with an age between 65 and 84 years. Patients of 85 years of age or older had a median LOS around nine hours [5]. Two older studies, published in 1984 and 1991, calculated a LOS around three hours for patients of 65 years of age or older [1,4].…”

“…This was an increased LOS in comparison with younger patients [1,7]. A more recent study performed in Switzerland published a median duration of stay at the ED of 6.5 hours for patients with an age between 65 and 84 years and a median duration of stay at the ED of nine hours for patients with an age of 85 years and older [5]. A review mentioned a 19 to 58% increased LOS for elderly patients [8].…”

Emergency Care Services

“…Several studies have demonstrated the increased presence of elderly patients in EDs (Georges, Jell and Todd, 2006;Vilpert et al, 2013;Pines et al, 2013). Elderly patients are found to be at increased risk of ED visits and ED return visits because of cognitive disorders or the presence of multiple comorbidities.…”