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Onen SH Onen F Mangeon JP Abidi H Courpron P Schmidt J 《Archives of gerontology and geriatrics》2005,41(2):191-200
Although elderly people are particularly vulnerable to the adverse effects of alcohol, alcohol use disorders in late life have received relatively little attention in the literature. Our objectives were to assess the prevalence of alcohol use disorders (abuse and dependence), the medical profile and psychosocial characteristics in elderly people visiting emergency department (ED). A cohort of 2405 patients aged over 60 who came to the ED of a university hospital during a 3-month period was studied. Alcohol use disorder diagnosis (DSM-IV), medical profile and social characteristics were collected from retrospective review of patient files. The data derived from 128 patients (mean age, 69.8+/-6.8 years; 87% males) with alcohol use disorders and 128 non-alcoholic controls. The prevalence of current alcohol use disorder was 5.3%. The most common current alcohol-induced disorders were alcohol intoxication and alcohol-induced mood disorder. Social factors associated with alcohol use disorders were being homeless, living alone, being divorced and never married. Falls and delirium were frequent ED admission circumstances in elderly drinkers. Drinkers more commonly presented with gastrointestinal disorders. In conclusion, alcohol use disorders among older patients admitted in ED are common and occur more frequently among men. Falls and delirium are the main ED admission circumstances in elderly drinkers. Alcohol use disorders are also associated with gastrointestinal problems. 相似文献
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Zev Wiener David Te-Wei Chiu Nathan Ivan Shapiro Shamai Aron Grossman 《Internal and emergency medicine》2014,9(3):331-334
Current data suggest that up to 60 % of patients presenting to the ED with syncope leave the hospital without a defined etiology. Although a relationship between syncope and substance abuse has been described, no study to date has looked at the relationship between syncope of unknown etiology and substance abuse in patients presenting to the ED. The objective of the study was to determine whether a history of or current substance abuse is associated with an increased incidence of syncope of unknown etiology in ED patients. A prospective, observational, cohort study of consecutive ED patients aged ≥18 who presented with syncope was conducted between 6/03 and 7/06. Patients were queried in the ED and charts reviewed about a history of or current substance abuse. Substance abuse was defined as consumption of >2 alcoholic beverages nightly, repetitive use of any illicit substances, or documentation by the patient’s physician of concern regarding suspected substance abuse. Data were analyzed using SAS with Chi-squared and Fisher’s exact tests. We enrolled 518 patients who presented to the ED after syncope, 161 of whom did not have an identifiable etiology for their syncopal event. 62 patients had a history of, or current substance abuse. Among patients with a history of, or current substance abuse, 45 % had unexplained syncope, as opposed to 29 % of patients without such a history (p = 0.01). Our results suggest that prior and current substance abuse is associated with increased incidence of syncope of unknown etiology. Patients evaluated in the ED or even hospitalized with syncope of unknown etiology may benefit from substance abuse screening and possibly detoxification referral. 相似文献
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目的分析急诊抢救室老年危重患者死亡风险。方法回顾性分析我院急诊抢救室收治的急危重症患者3174例,根据年龄分为老年组(≥65岁)1839例和非老年组(14~64岁)1335例,记录患者性别、年龄、就诊时间、诊断、转归以及死因等资料,比较2组患者的死亡风险。结果3174例急诊危重患者中老年人占57.94%。与非老年组比较,老年组女性比例、年龄、心血管及呼吸系统发病率明显升高,差异有统计学意义(P<0.05,P<0.01)。老年组前3位病因为心血管疾病(48.2%)、神经疾病(19.7%)及呼吸系统疾病(15.7%)。3174例患者中死亡305例,其中老年组和非老年组分别为204例和101例,老年组病死率明显高于非老年组(66.89%vs 33.11%,P=0.001)。老年组危重症死因前3位的分别为心血管系统、神经系统及呼吸系统疾病。老年组呼吸危重症病死率明显高于非老年组(21.1%vs 3.0%,P=0.000)。结论心血管病、神经疾病及呼吸系统疾病是急诊老年危重患者最常见病因,病死率高,其中呼吸危重症的死亡风险更高。 相似文献
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Patterns of use of the emergency department by elderly patients 总被引:6,自引:0,他引:6
W H Ettinger J A Casani P J Coon D C Muller K Piazza-Appel 《Journal of gerontology》1987,42(6):638-642
The spectrum of illness and use patterns of 540 elderly patients (greater than or equal to 65 years) admitted to an emergency department (ED) were compared to an equal number of nonelderly patients. The proportion of visits by the elderly group to the ED was similar to the proportion of elderly residents in the area surrounding the hospital. Elderly patients were more likely than nonelderly patients to have an emergent diagnosis (34.4 vs. 8.3%), to arrive by ambulance (54.6 vs. 23.5%), to be admitted to the hospital (51.1 vs. 14.4%), and to have a medical (as opposed to a surgical) illness (75.0 vs. 53.2%). The spectrum of diseases was different between the two groups. Elderly patients had a higher proportion of cardiac (28.4 vs. 7.2%) and pulmonary disease (5.3 vs. 2.8%). Nonelderly patients had more injuries (30.5 vs. 10.7%) and self-limited infectious disease (11.5 vs. 5.0%). The proportion of psychiatric disease and social problems was low in both groups, about 5%. Elderly patients had a significantly lower proportion of nonurgent diagnoses (19.4 vs. 32.0%) than the nonelderly patients. Use of the ED by elderly patients is different from nonelderly patients in that they are more likely to have a serious medical illness. There is little evidence that elderly persons use the ED for primary self-care or social problems. 相似文献
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Alcohol and illicit drug abuse are major health care problems frequently leading to emergency department admission. The aims of this survey were (1) to determine for the Ghent University Hospital how frequently substance abuse contributed to emergency department admissions, (2) to describe the most important clinical features of these patients and (3) to determine how frequently these patients were referred to appropriate psychiatric services. All 1,941 patients attending the emergency department during the month of September 2003 were registered by the attending emergency department personnel. After exclusion of 8 cases, 1,933 patients were included: 198 (10%) with substance abuse leading to the emergency department admission (= INTOX group) and 1,735 (90%) in the NON-INTOX group. Males and the 21-50 years age group were overrepresented in the INTOX group. Patients with substance abuse were also overrepresented during the night, but not during the weekend. Among the patients from the INTOX group the most frequent reason for the emergency department visit was a psychiatric problem (102/198; 51%). Traumatic lesions related to a fight (n= 19), to a traffic accident (n= 17) and to leisure time activities (n=30) were also frequent. In most patients, only alcohol was abused (144/198; 73%), most frequently chronically (102/144; 71%). In 13% (26/198), there was only illicit drug use, and in 14% (28/198) alcohol abuse was combined with illicit drug use. Among the 54 patients with illicit drug use (with or without alcohol abuse) the most frequently reported drugs were cannabis (54%), cocaine (41%), amphetamines (39%) and opiates (39%). With regard to referral to appropriate psychosocial services it was striking that 53% (19/36) of trauma patients with chronic substance abuse were not offered that type of help. We conclude that abuse of alcohol--and to a much lesser degree illicit drugs--is a frequent cause of emergency department admissions. Our data may help to convince and/or reinforce health care policy makers, emergency department medical directors and the public that alcohol consumption (much more than illicit drugs) is responsible for avoidable morbidity and mortality, and that well-co-ordinated strategies against unhealthy alcohol use are urgently needed. In this respect, the importance of detection and referral of emergency department patients with unhealthy alcohol use should be stressed. 相似文献
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L R Ricci 《Annals of emergency medicine》1986,15(6):711-716
Each child who presents with a suspicion of sexual abuse must have immediate access to a complete medical evaluation performed by a competent and knowledgeable examiner. This evaluation should include, at a minimum, a history, a complete physical examination with a detailed genital examination, treatment of identified medical problems, and collection of evidence. It is not appropriate to perform a cursory examination simply because there was a time delay between the abuse and the examination or because the history is suspect. Each sexual abuse workup must be medically and forensically complete. In addition, each child presenting with suggestive complaints should have sexual abuse strongly considered in the differential diagnosis. A report to the appropriate social and legal agencies is indicated even if the suspicion cannot be confirmed. If sexually abused children are to be examined in hospital emergency departments, a protocol should be developed to ensure rapid, thorough, uniform, and caring evaluation. With planning, preparation, and education, most current inadequacies in the emergency medical assessment of sexually abused children can be resolved so that child victims receive sensitive and comprehensive medical care. 相似文献
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Salvador Pita-Fernández Mónica Lombardía-CortiñaDomingo Orozco-Veltran Vicente Gil-Guillén 《Archives of gerontology and geriatrics》2011,53(2):e106
This study aimed to determine the clinical characteristics of elderly patients diagnosed with digitalis intoxication, on the Emergency Department, University Hospital Complex, A Coruña, Spain. During the study period (January-September 2008) cases were included in which digitalis intoxication was confirmed by plasma digoxin levels. We collected data on age, gender, base-line diseases, therapeutic indications for digoxin, functional classification, ejection fraction, plasma digoxin levels, creatinine clearance, ions, gasometry, electrocardiogram, concomitant medication, symptomatology and treatment. The results were: mean age 82.0 ± 6.6 years, predominantly female subjects (83.7%). The most prevalent pathologies were cardiac valvulopathy (81.0%), hypertension (68.3%) and ischemic cardiopathy (46.3%), 95.1% had a background of cardiac insufficiency, and 52.6% were in functional grade III. The mean digoxin level was 2.7 ± 0.69 ng/ml, 23.1% of the patients had a creatinine clearance of less than 60 ml/min/1.73 m2 and 2.6% had a severely reduced glomerular filtration rate (GFR) (clearance < 30 ml/min/1.73 m2). A negative correlation was found between digoxin levels and clearance (r = −0.22; p = 0.18) and between the levels and cardiac frequency (r = −0.35; p = 0.026). Of the patients, 47.5% presented bradycardia and 87.8% arrhythmias, most frequently auricular fibrillation. The most frequent symptoms were nausea (54.8%), fatigue (42.9%), vomiting (33.3%) and anorexia (28.6%). We conclude that clinical digestive symptoms in elderly women who are taking digitalis, with bradycardia and impaired renal functioning, should lead us to suspect digitalis intoxication. 相似文献
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Care of the elderly in the emergency department 总被引:9,自引:0,他引:9
We prospectively examined the care provided to 234 elderly patients (age greater than or equal to 65) and an equal number of nonelderly patients visiting the emergency department of an urban teaching hospital. Sociodemographic, treatment, cost, and outcome data were collected through ED record reviews and follow-up telephone interviews. The elderly comprised 19% of the ED population and were often nonwhite (31%), Medicaid recipients (39%), living alone (41%), and multiply and chronically impaired. Among old-old patients (age greater than or equal to 75), the most frequent reasons for visiting the ED (19%) were a self-care problem, a fall, or dehydration. Forty-five percent of old-old patients' visits were for true medical emergencies or urgencies. Compared to the nonelderly, the old-old more often were admitted (47% versus 18%, P = .0001), stayed a longer time in the ED (three hours versus 1.9 hours, P = .0001), and incurred a higher charge ($324 versus $208, P = .0001) Twenty-nine percent of these old-old patients who were not initially admitted returned within 14 days (recidivated). The recidivism rate for nonelderly patients was only half as high (15%) (P = .02). 相似文献
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The prevalence and documentation of impaired mental status in elderly emergency department patients 总被引:7,自引:0,他引:7
STUDY OBJECTIVE: We sought to determine the prevalence of mental status impairment in elderly emergency department patients and to assess documentation of and referrals by emergency physicians for mental status impairment after discharge from the ED. METHODS: We performed a prospective, observational study of a convenience sample of 297 patients 70 years or older presenting to an urban teaching hospital ED over a 12-month period. Patients were screened with the Orientation-Memory-Concentration examination for cognitive impairment and the Confusion Assessment Method for delirium. Documentation, dispositions, and referrals were abstracted from chart review. RESULTS: Two hundred ninety-seven of the 337 eligible patients were enrolled. Seventy-eight of the 297 (26%; 95% confidence interval [CI] 21% to 31%) patients had mental status impairment; 30 (10%; 95% CI 7% to 14%) had delirium; 48 (16%; 95% CI 12% to 20%) had cognitive impairment without delirium; 17 (6%; 95% CI 3% to 9%) screened positive on both examinations. Only 22 (28%; 95% CI 19% to 40%) of the 78 patients had any documentation of mental status impairment by the emergency physician. Specific mention of delirium, cognitive impairment, or an acceptable synonym was noted in 13 (17%; 95% CI 9% to 27%). Of 34 (44%; 95% CI 32% to 55%) patients with mental status impairment discharged home, only 6 (18%; 95% CI 7% to 35%) had plans documented by the emergency physician to address impairment. Eleven (37%; 95% CI 20% to 56%) of the 30 patients with delirium were discharged home. Sixteen (70%; 95% CI 47% to 87%) of the 23 patients with cognitive impairment who were discharged home had no prior history of dementia; these patients were less likely to have specialized assistance with care (13%; 95% CI 4% to 27%) than those with known dementia (58%; 95% CI 28% to 85%). CONCLUSION: Impaired mental status is common among older ED patients. Lack of documentation, admission, or referral by emergency physicians suggests a lack of recognition of this important problem. 相似文献
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OBJECTIVE: to identify risk factors for admission for patients aged 75 years and older after discharge from the emergency department (DEED: discharge of elderly from emergency department). DESIGN: Prospective evaluation of discharged elderly patients from the emergency department who were followed up after 4 weeks. SETTING: emergency department of a teaching hospital for 1 year. SUBJECTS: patients aged 75 and over discharged to their home or hostel. MAIN OUTCOME MEASURES: demographic data, indices of function and cognitive status and admission to hospital within 4 weeks. RESULTS: 468 patients aged 75 and over (mean age 81.7 years; range 75-98) were enrolled; 80 patients (17.1%) were admitted to hospital during the subsequent 4 weeks. Risk factors for admission included dependence in the following activities of daily living (relative risk; 95% confidence interval): bathing (2.41; 1.32-4.41); dressing (2.38; 1.22-4.63); stairs (1.60; 1.09-2.33); finance (1.66; 1.23-2.25); shopping (1.39; 1.12-1.73) and transport (1.61; 1.25-2.06), as well as use of a community nurse (1.88; 1.12-3.17). Logistic regression analysis found two variables to be significant in predicting admission or not: dependence in transport and use of a community nurse. CONCLUSIONS: older patients are at increased risk of readmission within 4 weeks of being sent home from the emergency department. It is possible to identify high-risk patients by a questionnaire. This allows targeting of these patients for more intensive follow-up in an attempt to ameliorate further deteriorations in their health. 相似文献