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The geriatric patient: Use of acute geriatrics units in the emergency care of elderly patients in France |
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| Authors: | D. Somme,C. LazaroviciM. Dramé ,P. BlancP.O. Lang,J.B. GauvainT. Voisin,R. GonthierB. De Waziè res,C. JeandelP. Couturier,F. Blanchard,O. Saint-Jean |
| Affiliation: | a Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Geriatrics Department, 20-40 rue Leblanc, 75015 Paris, France b University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, 51 rue Cognacq Jay, 51095 Reims, France c Reims Teaching Hospitals, Maison Blanche Hospital, Department of Clinical Gerontology, 45 rue Cognacq Jay, 51100 Reims, France d Center for Geriatric Medicine, Porte Madeleine Hospital, 1 rue Porte Madeleine, 45032 Orléans Cedex 1, France e Rehabilitation and Geriatrics Department, Hôpital des Trois Chênes, Geneva University Hospital, Ch. du Pont-Bochet 3, CH-1226Thônex/Genève, Switzerland f Geriatrics and Gerontology Center, Purpan University Hospital, Place du Docteur Baylac - TSA 40031, 31059 Toulouse Cedex 9, France g Clinical Gerontology Department, Hôpital de la Charité, University Hospital Saint Étienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France h Geriatrics Unit, University Hospital Gaston Doumergues, Place du Pr R. Debré, 30029 Nîmes, France i Clinical Gerontology Center, University Hospital de Colombière, 39, avenue Charles Flahaut, 34295 Montpellier Cedex 5, France j Geriatric Clinic, University Hospital Michallon, Boulevard de la Chantourne, 38700 La Tronche Grenoble, France k University Paris René Descartes, Faculté de Médecine, 15 rue de l’École de médecine, 75270 Paris Cedex, 06 Paris, France |
| Abstract: | We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR) = 1.79 (1.38-2.32) (95% confidence interval = 95% CI); “failure to thrive” syndrome OR = 1.54 (1.01-2.35), depression: OR = 1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR = 1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the “geriatrics patient” is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system. |
| Keywords: | Hospital system Pathway of care Emergency care system Geriatrics University setting |
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