Abstract
BackgroundAging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65–84 years during this period and to investigate the evolution of these comparisons over time.MethodsData considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated.ResultsBetween 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65–84 years. Compared to patients aged 65–84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010.ConclusionsOldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.
Highlights
Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs
The incidence rate for ED visits increased slightly, but significantly, between 2005 and 2010 in both age groups (65-84 y: relative risk (RR) 1.09, 95% Confidence interval (CI): 1.04-1.13, P = 0.040; 85+ y: Relative risks (RR) 1.16, 95% CI 1.08-1.24, P = 0.033), producing incidence rates for ED visits of 173/1,000 inhabitants aged 65-84 y and 387/1,000 inhabitants aged 85+ y
A unique contribution of the current study is the provision of specific information about ED use among the oldest-old segment of the elderly population aged over 85 years
Summary
Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. As their incidence rate is Several studies have investigated the increased presence of elderly patients in ED [9,10] These studies focused primarily on the increase in patients aged over 65 years, without describing the evolution over time of the agespecific burden on ED use among this heterogeneous population. The segment of the oldest-old population remained modest (less than 2.3% of the Swiss population in 2009) This situation will change in the 20 years as people aged 85 years and over become the fastest growing segment of the elderly population in most developed countries. A 72% rise is expected in this population group between 2010 and 2030 in Switzerland As a consequence, this part of the population will constitute the fastest growing group of ED users, leading to an aging of the ED patient mix
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