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

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 chi 2 analysis and Mann-Whitney U test (alpha = 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 less than .00001). More elderly than controls presented with conditions of either high or intermediate urgency (78% versus 61%; P less than .0003). The elderly more frequently presented with comorbid diseases (94% versus 63%; P less than .00001). Other findings for the elderly included a longer mean stay in the ED (185 versus 155 minutes; P less than .003), higher laboratory (78% versus 53%; P less than .00001) and radiology (77% versus 52%; P less than .00001) test rates, higher mean overall care charges ($471 versus $344; P less than .00001), and an admission rate (47% versus 19%; P less than .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.     

Care of the elderly in the emergency department

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).     

Patterns of use of the emergency department by elderly patients

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.     

Use of emergency departments by elderly patients: projections from a multicenter data base.

STUDY OBJECTIVES: To assess the use of emergency medical care by the elderly in the United States, including emergency department visits, level of ED care required, ambulance services, and hospital admission rate. SETTING AND PARTICIPANTS: A multicenter computerized data base of 70 hospitals in 25 states. DESIGN: A retrospective review of elderly patients seeking ED care and comparison of elderly and nonelderly patients. The data were then used to estimate the use of emergency medical services nationally. MEASUREMENTS AND MAIN RESULTS: Fifteen percent of the 1,193,743 ED visits were made by patients 65 years or older. Thirty-two percent of elderly patients seen in EDs were admitted to the hospital, compared with 7.5% of nonelderly patients. Seven percent of elderly patients were admitted to ICUs, compared with 1% of nonelderly patients. Thirty percent of elderly patients seeking emergency care used ambulance transports compared with 8% of nonelderly. It is estimated that 13,693,400 elderly patients were seen in EDs in 1990, with more than 4 million patients admitted to hospitals. Compared with the nonelderly, the elderly are 4.4 times more likely to use ambulance transport, 5.6 times more likely to be admitted to the hospital, 5.5 times more likely to be admitted to an intensive care bed, and 6.1 times more likely to be classified as a comprehensive ED level of service. In our sample, 36% of all patients arriving by ambulance to the ED, 43% of all ED admissions, and 48% of all intensive care admissions were geriatric patients. CONCLUSION: With the rapid growth of the size of the elderly population, it is important that we assess the emergency medical resources needed to care for the geriatric population.     

Prognostic factors in elderly multiple myeloma patients aged 65 years or older: Comparison with nonelderly patients with multiple myeloma

Background:   Although age is a prognostic factor in multiple myeloma (MM), the prognostic factors in elderly MM patients may be different to those in nonelderly MM patients due to the patient's age. The difference in the significance of prognostic factors between elderly MM patients and the nonelderly MM patients was studied.
Methods:   Forty-two elderly MM patients aged 65 years or older were compared with 68 nonelderly MM patients, who were less than 65 years of age. The characteristics of the elderly patients included: aged 65–81 years (median, 72 years); female/male ratio of 22 : 20; 24 IgG type cases, 13 IgA type cases, one non-secretory case and four cases of Bence-Jones type; one case of stage I, 12 cases at stage II and 29 cases at stage III. The prognostic factors were evaluated by means of univariate analysis and Cox's multivariate analysis.
Results:   The median survival time was significantly shorter in the elderly MM patients (24 months) than in the nonelderly patients (50 months) ( P  < 0.01). Of the univariate prognostic factors, corrected serum Ca (cCa), hemoglobin, serum P, bone marrow plasma cell and uric acid were significant prognostic factors in the elderly MM patients, while nine factors including those listed here, were significant in nonelderly controls. Multivariate analysis showed that serum cCa was the only independent prognostic factor ( P  = 0.019) in elderly MM patients, while serum P and bone lesions were significant prognostic factors in nonelderly MM patients.
Conclusion:   Corrected serum c. (cCa) was an independent prognostic factor in elderly MM patients.     

Geriatric patient emergency visits. Part II: Perceptions of visits by geriatric and younger patients.

OBJECTIVES: To compare group perceptions of reasons for emergency department care, ED use patterns, and the effect of illness on self-care ability for elderly and younger adult patients. DESIGN: Patient survey. SETTING: Six geographically distinct US hospital EDs. PARTICIPANTS: From each site, a stratified sample (approximately 7:3) of elderly (65 years and older) and nonelderly (21 to 64 years old) control ED patients treated during the same time period was contacted. METHODS: Three hundred ninety-nine elderly patients and 172 adult controls were interviewed using a structured survey instrument. Groups were compared using chi 2 analysis and the Mann-Whitney U test. RESULTS: Both the elderly and the control patients (49% versus 38%) commonly stated that the most important reason for coming to the ED was because they were "too sick to wait for an office visit." Of patients with a regular physician, both groups often were referred to the ED by their primary care provider (35% versus 26%). While the elderly had more visits to their primary care provider (3.3 versus 2.9 visits; P less than .00001), there was no difference in the number of ED visits (1.5 versus 1.6 visits) during the preceding six months. Of those released from the ED, more elderly noted deterioration in their ability to care for themselves as a result of their illness (21% versus 11%; P less than .03). CONCLUSION: The elderly use the ED for reasons similar to those for younger adults. Often they feel too ill to wait for an office visit or are referred in by their primary care provider. Elderly patients more commonly have difficulty with self care after release home, and emergency physicians must plan accordingly.     

Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients

Valid studies comparing the clinical characteristics among adult, elderly, and the oldest old bacteremic patients are lacking. We conducted a prospective, observational study in the emergency department (ED) of a university medical center between June 2001 and June 2002. All patients >18 years of age who registered in the ED with a clinically significant, culture-positive, bloodstream infection (BSI) were enrolled. Patients were divided into 3 groups based on age: 1) oldest old (> or =85 yr), 2) elderly (65-84 yr), and 3) adult (18-64 yr). The clinical and laboratory manifestations and 30-day mortality were recorded. Group comparisons were performed using the chi-square test or analysis of variance (ANOVA) test, as indicated. Survival was analyzed using the Kaplan-Meier method and the Cox-regression model, adjusted for potential confounders.A total of 890 cases of community-acquired BSI were eligible for analysis. Compared to the adult group, both the elderly and the oldest old patients had more atypical clinical manifestations, a higher propensity to develop organ failure, and a worse prognosis. Elderly patients had significantly less tachycardia (p = 0.001), but more acute respiratory (p = 0.007) and renal failure (p = 0.037); the oldest old patients had more afebrile episodes (p = 0.006), leukocytosis (p = 0.012), and more patients developed respiratory failure (p = 0.009), acute renal failure (p = 0.011), septic shock (p = 0.022), and altered mental status (p = 0.013). Urinary tract infections were the main source of BSI for both the elderly and oldest old, while the oldest old patients had significantly more pneumonia than the elderly or adults.As a group, older patients had fewer signs and symptoms of BSI, but a higher risk of organ failure and a worse prognosis than younger patients.     

Emphysematous Pancreatitis in the Elderly

BackgroundEmphysematous pancreatitis (EP) is an unusual medical emergency that presents with intraparenchymal pancreatic air in the setting of necrotizing infection. We aimed to determine the differences in the epidemiology, etiology, clinical presentation, symptoms and outcome of EP between elderly and nonelderly patients.Materials and MethodsA PubMed search was performed using the keywords “emphysematous pancreatitis,” “gas-forming pancreatitis” and “pancreatitis and pneumoperitoneum” from March 1959 to February 2019. Forty-two EP articles with 58 patients were enrolled in our study. We divided the patients into ≥65 (elderly, n = 25) and <65-year age groups (non-elderly, n = 33). Data on patient age, sex, comorbidities, symptoms, clinical findings, etiologies, laboratory results, treatments, outcomes and mortality were collected and analyzed using the Student's t test and chi-square test using IBM SPSS 20. P values < 0.05 (2-tailed) indicated statistical significance.ResultsAlcohol- and biliary pancreatitis-related EP were 4.95- and 4-fold, respectively, more frequent in the elderly than in the nonelderly (36% versus [vs.] 9.1%, P < 0.05). Fever was more frequent in the nonelderly than in the elderly (69.7% vs. 36%, P < 0.05). The elderly presented with more severe shock status (68% vs. 33.3%, P < 0.05) and received more surgical interventions than the nonelderly (60% vs. 30.3%, P < 0.05).ConclusionsBiliary pancreatitis is the most common type of EP in the elderly and has an atypical presentation with less fever, more severe shock, and more surgical interventions. In treating elderly patients with pancreatitis, immediate administration of adequate antibiotics, assisted drainage and early surgical intervention are needed to prevent shock.     

Care of the elderly in emergency departments: conclusions and recommendations.

Little attention is being paid to the special needs of elderly persons in emergency departments. Emergency health care professionals feel less comfortable caring for elderly than for nonelderly patients. The social and personal concerns of the elderly frequently are not addressed in ED encounters. There is a paucity of research and education in geriatric emergency medicine. Overall principles of care for elderly patients seeking emergency care have not been defined as they have for other special populations such as children. The disease-oriented model used for caring for nonelderly adult patients in EDs may not be appropriate for elderly patients. The emergency care of the elderly requires significantly more health care resources than does that of the nonelderly. Compared with nonelderly patients, elderly patients seeking emergency care are four times more likely to use ambulance services, five times more likely to be admitted to the hospital, five times more likely to be admitted to an intensive care bed, and six times more likely to receive comprehensive emergency services. Although 12% of the population is 65 years or older, this group accounted for 36% of all ambulance patient transports to EDs, 43% of all hospital ED admissions, and 48% of all critical care admissions from EDs. These problems are particularly important at this time because many hospitals and their EDs are faced with significant problems of overcrowding and inadequate resources to meet the health care needs of the communities they serve. Although the elderly are the fastest-growing segment of the population, little or no planning is ongoing to meet the emergency health care needs of the elderly in the future. The task force has provided specific recommendations for addressing these problems.     

Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp

Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp.Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing.A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms.Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.     

52例老年人肝癌非手术综合治疗疗效评价

目的　探讨老年人肝癌非手术治疗的疗效。　方法　回顾性分析５２例老年人肝癌的治疗效果,以同期１５０例非老年人肝癌为对照。老年肝癌患者中２４例行肝动脉化疗栓塞（ＴＡＣＥ）或肝动脉化疗灌注（ＨＡＩ）结合中药治疗,２８ 例行ＴＡＣＥ或ＨＡＩ结合外放射、中药治疗。　结果　老年组总有效率３８．５％ ,１、３、５ 年生存率分别为６６．７％ 、５１．０％ 、２８．８％ ;对照组总有效率４０．７％ ,１、３、５ 年生存率分别为５６．９％ 、２８．４％ 、１３．４％ 。两组有效率、副反应相近（Ｐ＞ ０．０５）,而３、５ 年生存率老年组明显优于对照组（Ｐ＜ ０．０１）。老年组行ＴＡＣＥ或ＨＡＩ结合外放射、中药三联治疗者生存率明显高于接受ＴＡＣＥ或ＨＡＩ结合中药二联治疗者（Ｐ＜ ０．０５）。　结论　老年人肝癌经积极治疗能取得一定效果,三联治疗较二联治疗更为有效。     

Acute abdominal pain among elderly patients

BACKGROUND: Diagnosis of acute abdominal pain in older persons is a challenge, with the age-related increase in concurrent diseases. In most western countries the number of elderly people is constantly rising, which means that an increasing proportion of patients admitted for abdominal pain at the emergency department are elderly. OBJECTIVE: To characterize differences in clinical presentation and diagnostic accuracy between younger and more elderly patients with acute abdominal pain. METHODS: Patients admitted to Mora Hospital with abdominal pain of up to seven days' duration were registered according to a detailed schedule. From 1st February 1997 to 1st June 2000, 557 patients aged 65-79 years and 274 patients aged > or = 80 years were registered. Patients aged 20-64 years (n = 1,458) served as a control group. RESULTS: A specific diagnosis, i.e. other than 'nonspecific abdominal pain', was established in 76 and 78% of the patients aged 65-79 and > or = 80 years respectively, and in 64% of those aged 20-64 (p < 0.001). Pain duration before admission increased with age (p < 0.003), as did frequency and duration of hospitalization (p < 0.0001). Hospital stay increased from 170 days per 100 emergency admissions in the control group to 320 and 458 days in the younger and older study groups, respectively. At the emergency department, older patients were more often misdiagnosed than control patients (52 vs. 45%; p = 0.002). At discharge the diagnosis was more accurate in the control group (86 vs. 77%; p < 0.0001). Hospital mortality was higher among older patients (23/831 vs. 2/1,458; p < 0.001). The admission-to-surgery interval was increased (1.8 vs. 0.9 days, p < 0.0001) in patients > or = 65 years. Rebound tenderness (p < 0.0001), local rigidity (p = 0.003) and rectal tenderness (p = 0.004) were less common in the older than in the control patients with peritonitis. In patients > or = 65 years, C-reactive protein did not differ between patients operated on and those not, contrary to the finding in patients < 65 years (p < 0.0001). CONCLUSION: Both the preliminary diagnosis at the emergency department and the discharge diagnosis were less reliable in elderly than in younger patients. Elderly patients more often had specific organic disease and arrived at the emergency department after a longer history of abdominal pain compared to younger patients.     

Patients who leave a pediatric emergency department without treatment

We describe a population of 296 patients (1.1% of 27,230 pediatric emergency department visits) who left a pediatric ED without treatment during a 12-month period. Most occurred on weekends (n = 120; 41%), registered between 4 PM and midnight (n = 174; 59%), were on public aid (n = 161; 54%), had no known source of health care (n = 188; 64%), and waited less than three hours before leaving (n = 187; 63%). Most were not seriously ill; 12 children (4%) had urgent or emergency problems. Minor trauma was the most common reason for the visit. Two hundred twenty-three (75%) were contacted by telephone two days later. A long waiting time was the most commonly cited reason for leaving (137/231; 59%). One hundred sixteen patients (52%) did not seek other medical care; 36 (16%) went to another hospital ED. Forty-eight hours after leaving without treatment, 112 patients (50%) were well, 65 (29%) had improved, 34 (15%) were unchanged, two (less than 1%) were worse, and seven (3%) had been hospitalized.     

Effects of the September 11th attacks on urgent and emergent medical evaluations in a Northern California managed care plan

PURPOSE: To determine whether the terrorist attacks on September 11, 2001, affected the health of persons far from the attacks, we studied rates of urgent and emergency medical evaluations among the 3 million persons enrolled in a managed care plan in Northern California. METHODS: Using a computerized database of all urgent care and emergency department evaluations, we monitored physician diagnoses made during the 6 weeks before and after September 11, 2001, at 16 hospitals in the Kaiser Permanente Medical Care Program. Actual rates of evaluations and diagnoses were compared with expected rates based on similar periods in 1998, 1999, and 2000. RESULTS: There were 4260 fewer urgent and emergent medical evaluations than expected during the 6 weeks beginning September 11, 2001 (-4%; 95% confidence interval [CI]: -3% to -5%; P <0.0001; N = 95,603). Emergency department visits occurred at the expected rate (-1%; 95% CI: -2% to 1%; P = 0.34), but urgent care visits were reduced (-9%; 95% CI: -8% to -11%; P <0.0001). Evaluations were particularly less frequent during the week beginning September 11 (-7%; 95% CI: -4% to -9%; P <0.0001), but a decrease persisted afterwards. Compared with expected rates, injuries (P <0.0001) and ill-defined/symptom-related diagnoses (P <0.0001) were less frequent, while gastrointestinal diagnoses (P = 0.01) were more frequent, during the 6 weeks after the attacks. Total urgent and emergent evaluations were mostly unchanged on September 11; only diagnoses associated with cardiac ischemia were more frequent (+70%; 95% CI: 10% to 163%; P = 0.02). CONCLUSION: Total urgent and emergent medical evaluations in a California managed care plan were reduced during the 6 weeks after the September 11th attacks. These results may help in allocation of resources during national disasters.     

Beneficial effect of preinfarction angina on in-hospital outcome is preserved in elderly patients undergoing coronary intervention for anterior acute myocardial infarction.

BACKGROUND: Preinfarction angina improves survival after acute myocardial infarction (AMI) in nonelderly but not elderly patients in the thrombolytic era. However, it remains unclear whether preinfarction angina has a beneficial effect on clinical outcome in elderly patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: The study group comprised 484 anterior AMI patients who were admitted within 24 h of onset and underwent emergency PCI. Patients were divided into 2 groups: those aged < 70 years (nonelderly patients, n = 290) and those aged > or = 70 years (elderly patients, n = 194). Angina within 24 h before AMI was present in 42% of nonelderly patients and in 37% of elderly patients. In nonelderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (1% vs 7%, p = 0.02). Similarly, in elderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (6% vs 16%, p = 0.03). Multivariate analysis showed that the absence of preinfarction angina was an independent predictor of in-hospital mortality in both nonelderly (odds ratio 4.20; 95% confidence interval (CI) 1.20-10.6; p = 0.04) and elderly patients (odds ratio 3.04; 95%CI 1.06-18.1; p = 0.04). CONCLUSIONS: Angina within the 24 h before AMI is associated with better in-hospital outcomes in elderly and nonelderly patients.     

Beneficial effect of prodromal angina pectoris is lost in elderly patients with acute myocardial infarction

BACKGROUND: Prodromal angina pectoris occurring shortly before the onset of acute myocardial infarction is associated with a favorable outcome by the mechanism of ischemic preconditioning. Recent experiments have reported that the beneficial effect of ischemic preconditioning are reversed in the aged heart. METHODS: We studied 990 patients who underwent coronary angiography within 12 hours after the onset of acute myocardial infarction. Patients were divided into 2 groups: those aged <70 years (nonelderly patients, n = 722) and those aged >/=70 years (elderly patients, n = 268). Prodromal angina in the 24 hours before infarction was found in 190 of 722 nonelderly patients and in 66 of 268 elderly patients (26% vs 25%, P =.61). RESULTS: In nonelderly patients, prodromal angina was associated with lower peak creatine kinase levels (2438 +/- 1939 IU/L vs 2837 +/- 2341 IU/L, P =.04), lower in-hospital mortality rates (3.7% vs 8.8%, P =.02), and better 5-year survival rates (P =. 007). On the contrary, in elderly patients there was no significant difference in peak creatine kinase levels (2427 +/- 2142 IU/L vs 2256 +/- 1551 IU/L, P =.51), in-hospital mortality rate (21.2% vs 17. 4%, P =.49), and 5-year survival rates (P =.47). A multivariate analysis showed that prodromal angina in the 24 hours before infarction was associated with 5-year survival rate in nonelderly patients (odds ratio 0.49, P =.009) but not in elderly patients (odds ratio l.12, P =.65). CONCLUSIONS: In nonelderly patients, prodromal angina in the 24 hours before infarction was associated with a smaller infarct size and better short- and long-term survival, suggesting a relation to ischemic preconditioning. However, such a beneficial effect was not observed in elderly patients.     

Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey

Background/PurposeElderly patients have higher rates of emergency department visits worldwide. Emergency department utilization by older elderly is much more than younger elderly due to their disease complexity, comorbidities, and severity. This study aimed to determine the sociodemographic and clinical characteristics of elderly patients admitted to the emergency department of a hospital and to compare attendance data regarding older age groups.MethodsAll older people admitted to the emergency department in 2011 were evaluated retrospectively. Patients aged 65–74 years were defined as younger elderly and those aged ≥75 years as older elderly. The prevalence of emergency admission, demographic information, reason for visit, time of admission, diagnosis of disease, and disposition of the two age groups were compared. The Chi-square test was used to analyze data.ResultsThe mean age of the elderly patients was 74.7 ± 6.8 years; 56.7% of them were female. Elderly patients accounted for 11.9% of all emergency department visits. The mean number of emergency department visits per year was 1.15 for older elderly patients and 0.75 for younger elderly patients (p < 0.001). The season in which emergency visits are most frequent was winter, and the most frequent presentation times were evening and night shifts (18:00–23:59 hours). The most common emergency department diagnosis among older and younger elderly patients was related to circulatory disease (26.3% and 21.2%, respectively; p < 0.001). Nearly 90% of the elderly were discharged from the emergency department. Older elderly patients were more likely to be admitted to the hospital than younger elderly patients (14.3% vs. 4.7%).ConclusionThe annual rates of admission to the emergency departments and hospitals were significantly higher in the older elderly population than in the younger elderly population. The most common diagnoses among elderly patients were disorders of the circulatory system.     

Increased medical attention needed for frail elderly initially admitted to the emergency department for lack of community support.

The demographic changes in society with growing numbers of elderly subjects will inevitably increase admission rates to acute emergency departments (AMU). Early discharge might augment emergency readmissions due to a relapse in medical conditions. Our aim was to study precipitating factors in frail elderly patients who got the diagnosis "lack of community support" after initial medical examination at an AMU, as well as discharge rates and one-year mortality. The study population was 380 cases of 18,015 patients attending the AMU at a city hospital during one year. Inclusion criteria were age above 65 years, and given the diagnosis "lack of community support" by a physician, defined as no other etiological or symptom diagnosis after an initial medical examination, and in some cases 24 to 48-hours observation. All but three medical records were checked. Reduced ability to eat, drink and walk prior to admission were noted among 22 to 58% of cases. Two thirds of the patients needed further medical care as inpatients, and physical medical causes were identified in 85% of the cases (mean number 3 causes); infectious diseases, cardiovascular diseases, dementia and trauma were the most prevalent factors. The median hospital stay was 14 days, and 10% had been discharged from the hospital the week prior to admission. The one-year mortality was 34%. The deceased had more precipitating physical causes, and were more often admitted to medical wards, but fewer had been referred to a senior consultant at the time of admission than survivors, adjusted for age (14% vs 42%, p < 0.05). Multiple medical conditions were noted in the majority of patients admitted to an emergency department with reduced abilities to cope with basic activities of daily life, even though a preliminary examination stated lack of social support as the underlying cause. The need for better medical attention seems important, especially for patients discharged directly home from an emergency department.     

急诊抢救室老年危重患者死亡风险分析

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。