Increased medical attention needed for frail elderly initially admitted to the Emergency Department for lack of community support

Abstract

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.