Introduction: Population ageing challenges Emergency Departments
(ED) with a population shift toward higher age groups. People over 65
years are heterogenous with respect to polymorbidity and functional
capacity. Complex situations become more prevalent among patients
aged 85+, the fastest growing segment of the elderly population
(+72% between 2010 and 2030).
Objectives: To identify the trend of ED admission rates for patients
aged 85+ and to compare the characteristics of their ED visits with the
one of patients aged 65-84.
Method: Retrospective analysis of 56162 ED admissions of patients
aged 65+ at the University of Lausanne Medical Center (CHUV), from
2005 to 2010. All visits of patients aged 65+ at the time of admission
were considered. Analyses focus on demographic characteristics, living
arrangement, hospital admission, and median Length of Stay (LOS) in
the ED. Data from 2010 were examined for the degree of emergency
(DE), the main reason for visiting the ED (Swiss triage scale) and
readmission at 30 days.
Results: Between 2005 and 2010, ED visits of patients aged 65 years
and over increased from 8228 to 10390/year (with a slight decrease
of women from 56% to 54%). This is an increment of +26% i.e. 5.9
patients/day more. Patients aged 85+ increased by +46% vs +20%
for the 65-84. ED visits of people aged 18-64 years raised by +20%.
Among patients over 65 years, the proportion of patients aged 85 and
more increased from 23% in 2005 to 27% in 2010.
In 2010, 85+ patients were more likely than 65-84 patients to come
from a NH setting (13% vs 4%), to be hospitalised (70% vs 59%) and
to stay longer in the ED (median LOS 9 hours vs 7 hours). Readmission
to ED within 30 days after discharge did not differ (85+: 14% vs 65-84:
12%) (similar proportions in 2005). In 2010, the first reason for patients
85+ to visit ED was fall/injury (27% vs 18% by 65-84), whereas the
main cause for patients aged 65-84 years was a cardiovascular disorder
(18% vs 16% by 85+). The part of high emergency cases was similar
for patients 85+ and 65-84 (42%).
Conclusion: Among aged patients those aged 85 and over are the
fastest growing group admitted to ED. Compared to their younger
counterparts, their reason to visit ED and their pattern of health
services utilization differ due to specific epidemiological conditions. ED
addressing specific needs of geriatric patients would improve their care
and lead to a better use of available resources.