Geriatric patient emergency visits part I: Comparison of visits by geriatric and younger patients

doi:10.1016/S0196-0644(05)81025-X

Annals of Emergency Medicine

Volume 21, Issue 7, July 1992, Pages 802-807

https://doi.org/10.1016/S0196-0644(05)81025-X Get rights and content

Objectives:

To describe emergency department use by the elderly, to define problems associated with emergency care of the elderly, and to compare these results with those for younger adult patients.

Design:

Retrospective, controlled chart review.

Setting:

Six geographically distinct US hospital EDs.

Participants:

From each site, a stratified sample (approximately 7:3) of elderly (65 years or older) and nonelderly (21 to 64 years old) control patients treated during the same time period was used.

Methods:

Standardized review of ED records and billing charges. Comparisons of elderly and control patient groups using χ² analysis and Mann-Whitney Utest (α = 0.05).

Results:

Four hundred eighteen elderly patients and 175 nonelderly controls were entered into the study. The elderly were more likely to arrive by ambulance (35% versus 11%; P< .00001). More elderly than controls presented with conditions of either high or intermediate urgency (78% versus 61%; P < .0003). The elderly more frequently presented with comorbid diseases (94% versus 63%; P < .00001). Other findings for the elderly included a longer mean stay in the ED (185 versus 155 minutes; P< .003), higher laboratory (78% versus 53%; P< .00001) and radiology (77% versus 52%; P< .00001) test rates, higher mean overall care charges ($471 versus $344; P < .00001), and an admission rate (47% versus 19%; P < .00001) twice that of younger adults.

Conclusion:

Resource use and charges associated with emergency care are higher for the elderly than for younger patients. Increases in emergency resources and personnel or improvement in efficiency will be needed to maintain emergency care at present levels as the US population continues to grow and age.

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Patients over the age of 65 who present to the Emergency Department (ED) are more likely to be admitted to the hospital and, if admitted, often have a longer length of stay (LOS) in the hospital than younger patients.
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We conducted a case-control study of the impact of a GEMA team in a large ED. The team screened patients ≥65 years of age for functional decline to determine the need for targeted interventions. Potential interventions included: occupational therapy consultation in the ED, rehabilitation placement, geriatric clinic referral, and delirium management. Our control population was unassessed geriatric ED patients seen in the six months before and after GEMA team implementation.
A total of 815 patients were assessed between June and November 2019. Assessed patients were more likely to be discharged from the ED (54% vs 29%, OR 2.06). Mean ED LOS was nineteen minutes longer in assessed patients (4.94 vs 4.62 h, p < 0.01). The mean hospital LOS was 25 h less in assessed patients (4.50 vs 5.54 days, p < 0.01). Assessed and unassessed patients who were admitted to the hospital had the same baseline health status as measured by the Charlson Comorbidity Index (median score 2, p = 0.087). The reduction in hospital LOS resulted in an estimated savings of $1.7 million per year using the national average cost for 24 h of inpatient care.
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We conducted a prospective study enrolling 831 patients aged 75 years and older between 2018 and 2020. Comprehensive geriatric assessment was performed on all patients, and the results were integrated into the care planning process.
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Although ED aims to treat acute and life-threatening conditions, older persons with geriatric syndromes are also at a substantially high risk of adverse outcomes, even mortality. Transitioning of the ED from disease-centric to function-centric services is important for responding to the changing health care needs of super-aged societies.
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: This study was funded in part by a grant from the John A Hartford Foundation, Inc, New York. The work of multiple research associates who participated in the data collection is gratefully acknowledged.

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Original contributionGeriatric patient emergency visits part I: Comparison of visits by geriatric and younger patients

Objectives:

Design:

Setting:

Participants:

Methods:

Results:

Conclusion:

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Clin Geriatr Med

Ann Emerg Med

Ann Emerg Med

Aging America: Trends and Projections

Original contribution
Geriatric patient emergency visits part I: Comparison of visits by geriatric and younger patients