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

Abstract

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.

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

“…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). To better understand whether the use was inappropriate, it was necessary to extract true LUCs from emergency cases.…”

“…As a result, we suggest that increasing primary and secondary preventive interventions for diseases, including geriatric syndrome, will reduce the number of elderly emergency patients who use ambulance services inappropriately (Aminzadeh and Dalziel 2002;Caplan et al 2004). After discharge from the ED, elderly patients have a high rate of adverse outcomes, including re-use of the ED, re-admittance to the hospital, and death (Salvi et al 2007); in the current study, more than 40% of all elderly ambulance patients who were classified as having initial emergencies were discharged. House calls made by a primary care physician are expected to reduce adverse outcomes (Salvi et al 2007).…”

“…The rate of ambulance use is especially high among elderly patients who, despite using the emergency department (ED) appropriately, may be using ambulance services for less urgent problems (Salvi et al 2007;Iwai et al 2008). Thus, the emergency medical system is becoming overloaded with patients who may not require emergency care.…”

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

“…3,5 Approximately 10%-45% of the patients will develop a decline in function that persists up to seven months post injury. [3][4][5][6][7][8][9][10][11][12][13] Functional decline, or the reduction in ability to perform self-care activities of daily living (ADL) because of a decrement in physical functioning, [14][15][16][17] is a common and serious problem in elderly patients. 16,17 Functional decline is associated with social isolation, reduced quality of life, and death.…”

“…16,17 Functional decline is associated with social isolation, reduced quality of life, and death. 3,5,7,8,14,[18][19][20][21][22] It is also an important predictor of hospitalization, 23,24 prolonged hospital stay, 25 repeat ED visits, 7,26 and the need for home care 25 . Moreover, functional decline is the most important predictor of admission to institutions and of disproportionate use of health services by the elderly population.…”