Older adults in the emergency department: Predicting physicians’ burden levels

Schumacher, John G.; Deimling, Gary T.; Meldon, Stephen W.; Woolard, Bert

doi:10.1016/j.jemermed.2005.07.008

Cited by 51 publications

(41 citation statements)

References 9 publications

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“…They also represent a significant burden on the emergency medical system (Schumacher et al 2006). A high proportion of these initial emergency cases are LUC (Iwai et al 2008), but this does not mean that elderly patients used the ED services inappropriately (Salvi et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs

Horibata¹,

Takemura

2015

Tohoku J. Exp. Med.

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Elderly patients with less urgent medical needs represent a high proportion of all emergency patients in Japan; this trend is gradually increasing, presenting a burden on the emergency medical system. To design effective interventions, it is important to understand the basic characteristics of emergency service use. For elderly Japanese patients, there is currently no detailed report on less urgent cases (LUC), or those cases that could be diagnosed by primary care physicians. Since there is a need for a timely reporting of detailed LUC data, we used data of 2004-2006 from an immediately available database at the Yao Tokushukai General Hospital. With a focus on LUC, we analyzed 7,800 cases of elderly patients, aged over 65 years, who were transported via ambulance to a secondary emergency hospital in Osaka. Of these, 3,354 patients (43.0%) were classified as having initial emergencies and were given outpatient care in the emergency department, and 1,544 patients (19.8%) were LUC, in which 541 subjects (6.9%) may have used ambulance services somewhat inappropriately owing to a lack of alternate transportation. In the remaining 1,003 patients, ambulance use could have been avoided if primary care clinics were available at night and during holidays. We therefore focus on three important points: awareness-raising activities to prevent inappropriate ambulance use, strengthening of transport services to healthcare facilities, and expanding primary care clinic office hours. This study is the first detailed report on the use of ambulance services in Japan by elderly patients with less urgent medical needs.

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Section: Discussionmentioning

confidence: 99%

Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs

Horibata¹,

Takemura

2015

Tohoku J. Exp. Med.

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“…In a recent study, older patients (≥65 years) usually treated by ED physicians are estimated to be "near 40%" [4]. In contrast, international epidemiological data show a very low prevalence of elderly patients (about 18% of all users, ranging between 11 and 23%) [5,6].…”

Section: The Epidemiological Loadmentioning

confidence: 99%

“…The clinical approach towards acutely ill elder patients presenting to the ED can be highly complicated, especially when physicians are not familiar with their management [4,5]. Atypical presentations, altered laboratory values, comorbidity, polypharmacy, communication problems (aphasia, deafness) and altered mental status (delirium, dementia) are frequent and complicate the collection of anamnesis.…”

Section: Facing Problems With Older People In the Edmentioning

confidence: 99%

The elderly in the emergency department: a critical review of problems and solutions

et al. 2007

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The elderly are an ever increasing population in overcrowded emergency departments (EDs) in many countries. They have multiple health problems and consume more time and resources than younger patients. They are more frequently admitted and experience adverse outcomes after they are discharged from the ED. These frail patients could require specific skills, instruments and organisational models of emergency care in order to look after their complex needs. As such, several approaches have been tried and tested to improve emergency care for them. This article analyses the epidemiological load and problems faced when confronted with elder ED patients. We critically review organisational models, clinical approaches and methodologies in order to reduce ED physicians' difficulties and to improve quality of care and outcomes for elder patients. Triage, clinical assessment and discharge are identified as critical moments during an emergency care process, and interesting and useful instruments are proposed as possible solutions.

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“…Prior studies have observed that the ratio of patients aged 65 years and older presenting to EDs in Turkey varied between 9% and 18% (1)(2)(3)(4)(5)(6). Studies in different countries have reported that this ratio varied between 15% and 47% (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

The Use of Quick Sofa (Qsofa) in Elderly Patients with Sepsis in the Intensive Care Unit

Geyik¹

2018

tjgeri

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Introduction:This study was prepared with the objective of determining the ratio of use of ambulances by the patients 65 years of age and older who applied to emergency department and the indicators for the use of ambulances.Materials and Method: This cross-sectional research study, enrolled patients at least 65 years of age or older, who applied to the emergency department in Izmir Dokuz Eylül University Hospital. Two measurement tools were prepared with the objective of gathering the study data. The first measuring tool was prepared with the objective of evaluating the indicators of ambulance use by the patients, whereas the second measuring tool was for the situations of using emergency department.Results: 555 patients were included in the study. Only 34.2% of these patients reported that they came to the emergency department with an ambulance. It was observed that patients living with their families, and those with medical emergencies, i.e. who did not experience a trauma or an accident, used ambulances less frequently for going to the emergency department (p<0.05). Among patients who came to the emergency department with private vehicles, 59.2% stated that they did not call an ambulance because they thought that it would be quicker to come with their own resources. On the other hand, among patients who came to the hospital with an ambulance, a ratio of 67.4% replied that they called the ambulance because of emergency. Conclusion:The results of this study suggest that public awareness about 112 ambulance systems should be increased, especially for elderly patients.Keywords: Geriatrics; Ambulance; Emergency Medical Services; Emergency Service, Hospital Giriş: Bu çalışma acil servise başvuran 65 yaş ve üzeri hastaların ambulans kullanım oranını ve ambulans kullanım belirleyicilerini saptamak amacıyla hazırlanmıştır.Gereç Yöntem: Kesitsel tipte planlanan bu araştırmanın evrenini, İzmir Dokuz Eylül Üniversitesi Hastanesi'nin acil servis birimine başvuran 65 yaş ve üstü hastalar oluşturmuştur. Çalışmanın verilerini toplamak amacı ile iki adet ölçme aracı hazırlanmıştır. Birinci ölçme aracı hastaların ambulans kullanım belirleyicilerini, ikinci ölçme aracı ise AS kullanım durumlarını değerlendirmek amacıyla hazırlanmıştır.Bulgular: Araştırmaya 555 hasta alınmıştır. Çalışmaya alınan hastaların %34.2'sinin acil servise ambulans ile geldiği bulunmuştur. Ambulans ile gelen hastalar ise, %67.4 oranında acil durum nedeni ile ambulansı aradıkları yanıtını vermiştir. Ailesi ile birlikte yaşayan ve nontravmatik hastaların, acil servise ulaşmak için daha az sıklıkta ambulans kullandığı görülmüştür (p<0.05). AS birimine özel araç ile gelen hastaların %59.2'lik kısmı, kendi olanaklarıyla gelmenin daha çabuk olacağını düşündükleri için ambulans aramadıklarını belirtmiştir.Sonuç: Bu çalışma özellikle yaşlı hastalarda 112 Ambulans sistemi hakkında halkın bilinçlendirilmesi gerektiğini ortaya koymaktadır.

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Older adults in the emergency department: Predicting physicians’ burden levels

Cited by 51 publications

References 9 publications

Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs

Inappropriate Use of Ambulance Services by Elderly Patients with Less Urgent Medical Needs

The elderly in the emergency department: a critical review of problems and solutions

The Use of Quick Sofa (Qsofa) in Elderly Patients with Sepsis in the Intensive Care Unit

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