Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study.
Journal
European journal of emergency medicine : official journal of the European Society for Emergency Medicine
ISSN: 1473-5695
Titre abrégé: Eur J Emerg Med
Pays: England
ID NLM: 9442482
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
pubmed:
1
2
2023
medline:
25
2
2023
entrez:
31
1
2023
Statut:
ppublish
Résumé
Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
Sections du résumé
BACKGROUND AND IMPORTANCE
Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries.
OBJECTIVE
The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs.
DESIGN SETTING AND PARTICIPANTS
An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included.
OUTCOME MEASURES
Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years).
MAIN RESULTS
A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay.
CONCLUSION
The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
Identifiants
pubmed: 36719188
doi: 10.1097/MEJ.0000000000000997
pii: 00063110-202304000-00010
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
117-124Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of ‘elderly’. Geriatr Gerontol Int 2006; 6:149–158.
Pines JM, Mullins PM, Cooper JK, Feng LB, Roth KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc 2013; 61:12–17.
Ellis G, Marshall T, Ritchie C. Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 2014; 9:2033–2043.
Ferrucci L, Giallauria F, Guralnik JM. Epidemiology of aging. Radiol Clin North Am 2008; 46:643–652.
Sir O, Hesselink G, Van Den Bogaert M, Akkermans RP, Schoon Y. Risk factors for prolonged length of stay of older patients in an academic emergency department: a retrospective cohort study. Emerg Med Int 2019; 2019:4937827.
Ergin M, Karamercan MA, Mehmet A, Yavuz Y, Yavafii O, Serinken M. Epidemiological characteristics of geriatric patients in emergency departments: results of a multicenter study. Tur J Geriatr 2015; 18:259–265.
Kekec Z, Koc A, Buyuk S. Review of geriatric patients hospitalization in emergency department. Eurasian J Emerg Med 2009; 8:21–24.
Tanderup A, Lassen AT, Rosholm JU, Ryg J. Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study. BMJ Open 2018; 8:e023803.
Roberts DC, McKay MP, Shaffer A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 2008; 51:769–774.
Dundar ZD, Ergin M, Karamercan MA, Ayranci K, Colak T, Tuncar A, et al. Modified early warning score and vitalpac early warning score in geriatric patients admitted to emergency department. Eur J Emerg Med 2016; 23:406–412.
Feral-Pierssens AL, Toury G, Sehimi F, Peschanski N, Laribi S, Carpentier A, et al. Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study. BMC Geriatr 2020; 20:355.
Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg Med 2010; 56:261–269.
Roussel-Laudrin S, Paillaud E, Alonso E, Caillet P, Herbaud S, Merlier I, et al. The establishment of geriatric intervention group and geriatric assessment at emergency of Henri-Mondor hospital. Rev Med Interne 2005; 26:458–466.
Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47.
Schrijver EJ, Toppinga Q, de Vries OJ, Kramer MH, Nanayakkara PW. An observational cohort study on geriatric patient profile in an emergency department in the Netherlands. Neth J Med 2013; 71:324–330.
McCusker J, Ionescu-Ittu R, Ciampi A, Vadeboncoeur A, Roberge D, Larouche D, et al. Hospital characteristics and emergency department care of older patients are associated with return visits. Acad Emerg Med 2007; 14:426–433.
Moons P, De Ridder K, Geyskens K, Sabbe M, Braes T, Flamaing J, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14:315–323.
Kennelly SP, Drumm B, Coughlan T, Collins R, O’Neill D, Romero-Ortuno R. Characteristics and outcomes of older persons attending the emergency department: a retrospective cohort study. QJM 2014; 107:977–987.
Tanderup A, Ryg J, Rosholm JU, Lassen AT. Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study. BMJ Open 2019; 9:e026881.
Covino M, Petruzziello C, Onder G, Migneco A, Simeoni B, Franceschi F, et al. A 12-year retrospective analysis of differences between elderly and oldest old patients referred to the emergency department of a large tertiary hospital. Maturitas 2019; 120:7–11.
Eurostat Statistics Explained. Population structure and ageing; 2022. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing . [Accessed 01 December 2022]
Kuzuya M. Era of geriatric medical challenges: multimorbidity among older patients. Geriatr Gerontol Int 2019; 19:699–704.
Aubert CE, Streit S, Da Costa BR, Collet TH, Cornuz J, Gaspoz JM, et al. Polypharmacy and specific comorbidities in university primary care settings. Eur J Intern Med 2016; 35:35–42.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012; 380:37–43.
King DE, Xiang J, Pilkerton CS. Multimorbidity Trends in United States Adults, 1988-2014. J Am Board Fam Med 2018; 31:503–513.
Organization WH. WHO. Global report on diabetes. Publications of the World Health Organization Switzerland; 2016. pp. 1–88.
Meijers JMM, Halfens RJG, Neyens JCL, Luiking YC, Verlaan G, Schols JMGA. Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility. J Nutr Health Aging 2012; 16:654–658.
Gusdal AK, Johansson-Pajala RM, Arkkukangas M, Ekholm A, Zander V. Preventing falls and malnutrition among older adults in municipal residential care in Sweden: a registry study. SAGE Open Nurs 2021; 7:23779608211026161.
Moreland B, Kakara R, Henry A. Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years – United States, 2012-2018. MMWR Morb Mortal Wkly Rep 2020; 69:875–881.
Latham LP, Ackroyd-Stolarz S. Emergency department utilization by older adults: a descriptive study. Can Geriatr J 2014; 17:118–125.
Hjalmarsson A, Holmberg M, Asp M, Östlund G, Nilsson KW, Kerstis B. Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study. BMC Emerg Med 2020; 20:94.
Dundar ZD, Ayranci MK. Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey. Acta Clin Belg 2020; 75:405–410.