Elderly Emergency Department Patients Research Articles

Multidimensional frailty in elderly emergency department patients: unveiling the prevalence and significance of social frailty.

This study aimed to assess the prevalence and factors of physical, psychological, and social frailty among older adults in the emergency department, comparing these data with community population to understand emergency setting manifestations. Conducted at the Emergency Department of National Taiwan University BioMedical Park Hospital, this prospective observational cohort study enrolled older adult patients over a three-month period. Frailty assessments included the Study of Osteoporotic Fractures scale for physical frailty, the Tilburg Frailty Indicator for psychological frailty, and the Makizako Social Frailty Index for social frailty. Data analysis involved a multivariable logistic model to determine the risk factors associated with each frailty type. Out of 991 older adult individuals seeking medical care, 207 participated in the study. The study found high prevalence rates of frailty: 46.38% for physical, 41.06% for psychological, and 48.79% for social frailty. Risk factors for frailty included older age and a history of falls. Interestingly, the prevalence of social frailty was notably higher than physical and psychological frailty. Gender and polypharmacy showed no significant association with any frailty type. This research reveals high physical, psychological, and social frailty among older ED patients, especially noting social frailty's prevalence. It highlights the importance for emergency care to adopt holistic care strategies that address older adults' multifaceted health challenges, suggesting a paradigm shift in current healthcare practices to better cater to the multifaceted needs of this vulnerable population.

Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

ObjectiveTo estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. MethodsAll patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. ResultsWe included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0–28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39–1015. and 42.6, 3.74–485, respectively and hypoxemia (2.14, 1.27–3.61; and 1.87, 1.19–2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04–4.83; and 2.48, 1.27–4.86) and age (per 10-year increment; 1.54, 1.04–2.29; and 1.60, 1.13–2.28). The combined post-discharge adverse event was not associated with any characteristic. ConclusionsAHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.

Referral of community-dwelling older adults from eight emergency departments in Canada: A secondary analysis of cross-sectional data from the interRAI multinational emergency department (ED) cohort study

Background: Emergency Department (ED) overcrowding, unnecessary hospitalization, and alternate level of care has been identified as a major issue in Canada and around the world. This problem especially impacts older adult populations, who are at elevated risk of functional decline and adverse events in hospital-centric systems. This study uses data from the interRAI ED Contact Assessment (ED-CA)[1], a comprehensive geriatric assessment used in the ED, to improve our understanding of ED systems of referral to community resources.
 Target Audience: ED staff in clinical and leadership positions interested in better understanding community referral processes to improve care for community-dwelling older adults.
 Methods: This study is a secondary analysis of cross-sectional Canadian data from a cohort study of elderly ED patients. The cohort of community-dwelling patients aged 65 and older presented to the ED between April 2017 and July 2018. They were screened and recruited in 10 EDs across Ontario, Quebec, and Newfoundland. The data were analyzed using frequency and logistic regression analyses, then the results were interpreted in collaboration with two geriatricians and one physiotherapist.
 What was done: This study explored referral patterns and identified predictors of referral from the ED to five different community health services (occupational therapy, physiotherapy, home care, social work, and/or specialized geriatric services) for supporting community-dwelling older adults. 
 Results: We found that the sample (n=1055) was frail, with high needs and a high risk of ED revisit and institutionalization. Over half of the sample was referred to home care, occupational therapy, and/or physiotherapy, while only 16% were referred to specialized geriatric services. Most patients received multiple referrals from the ED. Province was the most impactful predictor for referral to occupational therapy or physiotherapy (OR for Ontario vs. Quebec=62.12, 95% CI [19.04, 202.70]) and home care (OR for Ontario vs. Quebec=12.09, 95% CI [5.81, 25.17]), while having an unstable condition was the most impactful predictor for social work referral (OR=5.51, 95% CI [3.78, 8.02]) and weight loss was the most impactful predictor for specialized geriatric service referral (OR=8.13, 95% CI [5.49, 12.04]). Other notable predictors included having overwhelmed family members, self-rated health, and having had a fall in the last 90 days.
 Key Learnings: Occupational therapy, physiotherapy, home care, social work, and specialized geriatric services are distinct services, specialized in addressing a specific set of care needs. We learned that specialized geriatric services are underutilized and may be poorly understood.
 Next Steps: To improve the quality of ED care, we have provided recommendations for restructuring care processes to promote shifts in clinical culture, evidence-informed decision-making, and proactive referral to community health services.

Aspectos epidemiológicos y de manejo clínico relativos a las neumonías diagnosticadas en urgencias en pacientes mayores en España: resultados del estudio EDEN-29

ObjectivesTo estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED. MethodsPatients ≥65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospital and 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalized patients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC). Results591 patients with pneumonia attended in the ED were included (annual incidence of 18.4 per 1,000 inhabitants). A total of 78% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR=4.453, 95%CI=2.361-8.400; and OR=3.497, 95%CI=1.578- 7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC=0.702, 95%CI=0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798). ConclusionsPneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the most frequent factor associated with adverse events. The biomarkers analyzed do not have a good predictive ability to predict adverse events.

Bibliometric Study on Geriatric Emergencies: Intellectual Structure, Prominent Themes, and Future-Directing Topics

Objective: This study aims to identify the intellectual structure, prominent themes, and diseases associated with geriatric emergency care. Additionally, it seeks to establish research questions for future studies. Material and Methods: Co-citation and co-occurrence analyses were conducted for bibliometric evaluations. The Web of Science database was utilized. Diseases mentioned in 939 articles were identified through thematic coding analysis of abstracts and titles. Finally, questions for the future agenda were prepared. Bibliometric analyses were carried out using R-based Bibliometrix software. Results: Co-citation analysis revealed two main themes: "Adverse Outcomes in Elderly Post-Emergency Service, Delirium Identification, and Multidisciplinary Interventions" and "Diagnosis and Management of Cognitive Dysfunction in Elderly Emergency Department Patients." Co-occurrence analyses indicate that the literature clusters around key themes such as "risk and prevalence," "management and epidemiology," "physical performance," "elderly care and outcomes," "elderly and community," "survival and prognosis," and "stroke and related diseases." According to the list of diseases, the ten most frequently studied diseases in geriatric emergency articles are, in order, Cancer, Stroke, Dementia, Depression, Delirium, Alzheimer's, Carcinoma, Metabolic Syndrome, Type 2 Diabetes, and Heart Failure. Conclusion: Adopting a comprehensive approach is essential for improving older adults' quality of life and independenceHealthcare providers and decision-makers should take these findings into consideration, as they make significant contributions to the health and independence of the elderly population. Furthermore, questions for future research agendas have been formulated.

Frailty Status and Related Factors in Elderly Patients in Intensive Care for Acute Conditions in China.

Objective: Frailty is a complex age-related clinical disorder characterized by the decreased physiological capacity of multiple organ systems, leading to increased susceptibility to stressors. Because the clinical manifestations of frailty are heterogeneous, accurately diagnosing the degree of frailty and its predisposing factors is important. We investigated the prevalence of frailty and the related risk factors in elderly patients in emergency departments (EDs) in China using a clinical frailty scale (CFS) and a comprehensive geriatric assessment (CGA) tool.Methods: Elderly patients who were scheduled to be discharged from the acute ward of an ED within one week were recruited. They were asked to complete a set of surveys using CGA forms, comprising a CFS, a Nutritional Risk Screening 2002 form, laboratory tests for albumin level and body mass index, a Mini-Cog test for cognitive status, Barthel's activities of daily living index, an instrumental activities of daily living (IADL) assessment, a Geriatric Depression Scale-15 (GDS-15) assessment and a Cumulative Illness Rating Scale-Geriatric assessment.Results: Frailty prevalence in the recruited elderly patients was 33.33%. Frail elderly patients (CF≥5) also had more comorbidities, higher depression scores, and nutritional risks along with lower body mass indices, weight, quality-of-life scores and physical function scores. Cognitive impairment, depression, and education level were found to be the main impact factors on frailty.Conclusion: Frail elderly patients had greater cognitive problems and higher levels of depression besides physical dysfunction, which further aggravates frailty in older patients.

Differences in Characteristics and Length of Stay of Elderly Emergency Patients before and after the Outbreak of COVID-19.

(1) Background: COVID-19 has spread worldwide and affected Taiwan's medical system and people's lives. This study aimed to explore the impact of medical utilization on the characteristics and length of stay (LOS) of elderly emergency department (ED) patients before and after COVID-19; (2) Methods: We gathered ED visits from January to September 2019 (pre-pandemic group) and from January to September 2020 (pandemic group). The data analysis methods included descriptive statistics, the Pearson's chi-square test, the independent sample t-test, and binary logistic regression; (3) Results: In 2020, during COVID-19, a significant decrease in ED monthly visits occurred from January; the maximum decrease was 32% in March. The average LOS during COVID-19 was shortened, with a significant reduction in diagnoses compared with the pre-pandemic period; (4) Conclusions: The threat of COVID-19 has changed the elderly's behavior in ED visits and shortened the LOS of ED. The study's results emphasize the importance of analyzing the medical utilization of elderly ED patients and understanding the medical quality of healthcare institutions. With Taiwan's rapidly aging society, the demand for healthcare increases from time to time. The overcrowding of medical attention is often a problem. The results recommend that the overcrowding problem has the opportunity to be solved.

Effect of Optimized Emergency Care on Treatment Rate and Prognosis of Elderly Patients with Acute Stroke in Emergency Department: A Systematic Review and Meta-Analysis.

Objective This research was to detect the treatment rate and prognosis of elderly patients with acute stroke in emergency department by the optimization of emergency care applying meta-analysis. Methods The online databases including PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) were searched. The retrieval time limit was set from the establishment of the database to the present. The data were extracted independently by two investigators. The bias of per publication was assessed following Cochrane manual 5.1.0 standard. RevMan5.4 statistical software was used to analyze the collected data by meta. Results The 8 randomized controlled trials included in this meta-analysis all reported patients' baseline status. The meta-analysis of the rescue time of the study group and the control group (CH2 = 1507.80, df = 4, P ≤ 0.001, and I2 = 100%) showed that the emergency nursing with optimized emergency procedures can shorten the rescue of elderly acute stroke patients in the emergency department time. There are 6 literatures reporting the case fatality rate (Chi2 = 1.12, df = 5, P = 0.95 > 0.05, and I2 = 0%), and the death rate of the study group was not higher than that of the control group (Z = 4.4 and P < 0.0001). The use of optimized first aid can reduce mortality in elderly patients with acute stroke. Six articles on disability rate reported the heterogeneity of disability rate (CH2 = 2.88, df = 5, P = 0.72 > 0.05, and I2 = 0%), indicating that the disability rate in the study group was lower than that in the control group (Z = 3.91 and P < 0.0001), indicating that emergency nursing by optimizing emergency procedures can reduce the disability rate of elderly stroke patients in emergency department. Conclusion Optimizing the emergency care process can effectively improve the emergency rate and prognosis of elderly patients with acute stroke in emergency department; however, further research with higher methodological quality and longer intervention time are needed to verify later.

Anaphylaxis among elderly emergency department patients in a large health system in New York

BackgroundAnaphylaxis in the elderly is poorly understood. ObjectiveTo elucidate demographic, clinical, and management characteristics of older adults presenting to emergency departments (EDs) with National Institute of Allergy and Infectious Diseases (NIAID) criteria-confirmed anaphylaxis vs milder, non-anaphylactic acute allergic reactions (AARs). MethodsA retrospective analysis of ED patients more than or equal to 65 years was conducted, using anaphylaxis International Classification of Diseases, Ninth Revision (ICD-9) codes or ICD-9–based algorithms incorporating the NIAID diagnostic criteria. Descriptive statistics were generated, and the abovementioned characteristics were compared between cohorts. ResultsOf 164 eligible visits, 71 (43.3%), 90 (54.9%), and 3 (1.8%) cases were identified by ICD-9 codes, the algorithms, or both, respectively. Only half fulfilled NIAID diagnostic criteria. Compared with the non-anaphylactic AAR group, criteria-confirmed anaphylaxis group had lower drug allergy rates (43.9% vs 61.0%, P = .03) but higher food allergy rates (26.8% vs 12.2%, P = .02). For the criteria-confirmed anaphylaxis group, presenting signs and symptoms in descending frequency were mucocutaneous, respiratory, cardiovascular, and gastrointestinal. Criteria-confirmed anaphylaxis group had higher rates of prior anaphylaxis (13.4% vs 2.4%, P = .009), pre-ED (12.2% vs 0.0%, P = .001) or ED (72.0% vs 4.9%, P < .001) epinephrine administration, and allergy referral (17.1% vs 2.4%, P = .002). Tryptase levels were rarely ordered, occurring once in the criteria-confirmed anaphylaxis group and never in the non-anaphylactic AAR group. Despite low mortality (n = 1), 64.6% of the criteria-confirmed anaphylaxis cohort required hospitalization, with 23.2% admitted to intensive care unit. ConclusionDiagnosis of elderly ED patients with anaphylaxis remains suboptimal. Identifying NIAID criteria-confirmed cases remain challenging, using the existing methods. Management of these patients poorly adheres to current guidelines.

Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study.

PurposeTo diagnose delirium and identify risk factors for its development in elderly patients in the emergency department (ED) and intensive care units (ICU) at the National Geriatric Hospital (Vietnam).Patients and MethodsA cross-sectional observational study was conducted with a convenience sample of non-surgical patients admitted to ED and ICU at Hanoi National Geriatric Hospital in Vietnam. In total, 163 patients met the selection criteria and were included in the study. Screening involved using the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The diagnosis was established according to the DSM-5 and ICD-10 codes.ResultsDelirium was found in a total of 106 (63.1%) patients. The factors significantly affecting its development were vision impairment (OR, 3.3; 95% CI, 1.5 to 7.4, P=0.003), hearing impairment (OR, 3.6; 95% CI, 1.77 to 7.36, P=0.0001), acute or chronic kidney failure (OR, 7.1; 95% CI, 2.05 to 6.39, P<0.001), respiratory disorders (OR, 2.7; 95% CI, 1.4 to 5.2, P=0.004), and malnutrition (OR, 9.17; 95% CI, 3.43–24.5, P=0.0001). The list also include the fall risk factors (OR, 12.2; 95% CI, 4.1–36.3, P=0.0001), frailty (OR, 8.35; 95% CI, 3.4–20.6, P=0.0001), activities of daily living (OR, 8.35; 95% CI, 3.4–20.6, P=0.0001), hyponatremia (OR, 2.48; 95% CI, 1.07 to 5.75, P=0.001), hypernatremia (OR, 13.1; 95% CI, 1.67 to 2.5, P=0.001), and treatment interventions. In addition, delirium was linked to the duration of ICU admission (OR, 6.53; 95% CI, 4.5–25.5, P < 0.0001).ConclusionThe CAM/CAM-ICU diagnostic algorithm makes it possible to diagnose delirium successfully. The present study confirmed the role of several premorbid and triggering factors in the occurrence of delirium in elderly patients in ED and ICU. There is a need for further research into risk factors for delirium in elderly patients.

Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US.

IntroductionPrior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States’ studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking.MethodsUsing the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US.ResultsResults are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42–1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33–2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes.ConclusionOur findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician’s point of view.

Evaluation of fluid intake habit and fuid importance among middle age and elderly patients

The aim is to evaluate fluid intake and knowledge about fluid intake importance among middle age and elderly patients in emergency department.&#x0D; Methods. The study performed in emergency department. 110 patients participated in the study. Patients were divided in 2 groups according age group: 45–49 age (middle age) and ≥ 60 (elderlyAuthors according literature review made questionnaire). Bioethics persission was given by Lithuanian University of Health Sciences Bioethics center (No. BEC-SLF(N)-229).&#x0D; Results. Of all patients, 52.7 proc. were women and 47.3 proc. men. Water drink more women (82.8 proc.), patient with secondary education (84.0 proc) and living in countryside. Mineal water drink more men (36.5 proc.), patients with high education (38.2 proc.) and living in cities (39.1 proc.). During day 1.5–2 litres of fluid drink 28.2 proc. of patients (accordingly middle age 29.4 proc. and 27.1 proc. elderly). Only 1 litre of fluid drink more elderly patients than middle age (accordingly 32.2 proc. and 19.6 proc.). The most of patients (66.3 proc.) sometimes felt thirst during the day. Acoording the most (51.8 proc.) patients opinion (accordingly eldelry 57.6 proc. and middle age 45.1 proc.) people must intake 1.5–2 litred of fluid per day. The most (46.0 proc.) of middle age patients knew about fluid intake from Internet, the most of elderly (50,0 proc.) knew more from journals, magazines. Community nurses gave less information for middle age group and elderly patients (accordingly 6.3 proc. and 16.7 proc.).&#x0D; Conclusions. Patients of emergency department intake not enough fluid, even one third of elderly patients drink only less than 1 litre per day. The most popular fluid in both groups were water and tea. Patients the most information about fluid intake gave from Internet, publications, and least from community nurses.

The Value of National Early Warning Score in Predicting the Condition and Prognosis of Elderly Patients in Emergency Department

To investigate the value of national early warning score for predicting the condition and prognosis of elderly patients in the emergency department. 1034 elderly patients admitted to our hospital from January 2019 to December 2019 were divided into general ward group and intensive care unit group according to the direction of emergency treatment; meanwhile after 1 mo, patients were divided into death and survival groups according to their actual conditions. All patients were evaluated using the modified early warning score and the national early warning score and the prognostic value of the national early warning score for elderly patients was assessed using the receiver operating characteristic curve. Comparison of gender, age, systolic blood pressure and body temperature between the general ward group and intensive care unit group, the differences were not statistically significant (p>0.05), the differences in consciousness, respiratory support, mode of admission and renal failure between the two groups were statistically significant (p<0.05). The pulse rate, respiratory rate, modified early warning score and national early warning score were significantly higher and oxygen saturation was significantly lower in the intensive care unit group than that of in the general ward group (p<0.05). In the death group and the survival group, the differences in sex, age, systolic blood pressure, pain and temperature were not statistically significant (p>0.05); the differences in consciousness, respiratory support, mode of admission and renal failure were statistically significant (p<0.05). The pulse rate, respiratory rate, modified early warning score and national early warning score were significantly higher and oxygen saturation was significantly lower in the death group than that of in the survival group (p<0.05). Frequency, modified early warning score and correction modified early warning score were all higher than those in the surviving group and oxygen saturation was lower than those in the surviving group. The results of receiver operating characteristic curve showed that the index and sensitivity of national early warning score was significantly higher than that of modified early warning score. Both modified early warning score and national early warning score can predict the condition and prognosis of elderly patients in the emergency department. The national early warning score is closer to the actual situation of elderly patients, more accurate and comprehensive than the modified early warning score score in reflecting the criticality and changes in the condition of elderly patients and has a greater ability to predict the prognosis of patientsis.

Diagnosing Dyspneic Older Adult Emergency Department Patients: A Pilot Study.

Dyspnea is the second leading cause of US emergency department (ED) visits and an independent predictor of morbidity and mortality1 in older adult patients aged ≥65 years. Unfortunately, the diagnosis of the cause of dyspnea presents diagnostic challenges to emergency physicians2-4 that disproportionately affects older adults.5 One in 5 dyspneic older adults experience missed diagnosis in the ED2 and 21% are treated for ≥1 pneumonia, acute exacerbation of chronic obstructive pulmonary disease [COPD], and acute exacerbation of heart failure [HF].5 Importantly, some may have multiple causes of their dyspnea but accurate diagnosis remains critical.

Predictors of Mortality in Elderly and Very Elderly Emergency Patients with Sepsis: A Retrospective Study.

IntroductionElderly patients are at increased risk of developing sepsis and its adverse outcomes. Diagnosing and prognosing sepsis is particularly challenging in older patients, especially early at emergency department (ED) arrival. We aimed to study and compare the characteristics of elderly and very elderly ED patients with sepsis and determine baseline factors associated with in-hospital mortality. We also compared prognostic accuracy of the criteria for systemic inflammatory response syndrome, quick sequential organ failure assessment (qSOFA), and the National Early Warning Score in predicting mortality.MethodsWe conducted a retrospective study at the ED of Siriraj Hospital Mahidol University in Bangkok, Thailand. Patients over 18 years old who were diagnosed and treated for sepsis in the ED between August 2018–July 2019 were included. We categorized patients into non-elderly (aged <65 years), elderly (aged 65–79 years), and the very elderly (aged >80 years) groups. The primary outcome was in-hospital mortality. Baseline demographics, comorbidities, source and etiology of sepsis, including physiologic variables, were compared and analyzed to identify predictors of mortality. We calculated and compared the area under the receiver operator characteristics curves (AUROC) of early warning scores.ResultsOf 1616 ED patients with sepsis, 668 (41.3%) were very elderly, 512 (31.7%) were elderly, and 436 (27.0%) were non-elderly. The mortality rate was highest in the very elderly, followed by the elderly and the non-elderly groups (32.3%, 25.8%, and 24.8%, respectively). Factors associated with mortality in the very elderly included the following: age; do-not-resuscitate (DNR) status; history of recent admission <3 months; respiratory tract infection; systolic blood pressure <100 millimeters mercury (SBP<100); oxygen saturation; and Glasgow Coma Scale (GCS) score. Factors associated with mortality in the elderly were DNR status, body temperature, and GCS score. qSOFA had the highest AUROC in predicting in-hospital mortality in both very elderly and elderly patients (AUROC 0.60 [95% confidence interval {CI}, 0.55–0.65] and 0.55 [95% CI, 0.49–0.61, respectively]).ConclusionThe mortality rate in the very elderly was higher than in the younger populations. Age, DNR status, recent admission, respiratory tract infection, SBP<100, oxygen saturation. and GCS score independently predicted hospital mortality in very elderly patients. The qSOFA score had better but only moderate accuracy in predicting mortality in elderly and very elderly sepsis patients.

Opioid Use Is Not Associated with Delirium in Elderly ED Patients

Elderly patients are at risk for delirium during hospitalizations or prolonged emergency department (ED) stays. To determine whether uncontrolled pain

Predictors of 3-month mortality in elderly patients visiting the emergency department: A retrospective cohort study

Objective: Various studies have documented the cases of failure to thrive among elderly patients following admission to the emergency department (ED), leading to early mortality. However, studies determining the predictors of 3-month mortality in elderly patients visiting the ED in Indonesia are lacking. Materials and Methods: A retrospective cohort study was performed using secondary data of elderly patients in the ED at Dr. Cipto Mangunkusumo National Hospital between September 2016 and January 2017. We gathered 3-month mortality data using medical records and telephone interviews. Functional status decline, cognitive function impairment, polypharmacy, delirium, frailty, hypoalbuminemia, malnutrition risk, and Rapid Emergency Medicine Score were analyzed using the Chi-square test. Multivariate logistic regression analysis was performed to identify independent predictors of mortality. Results: From the 501 patients studied, 36 (7.2%) were lost to follow-up. A total of 465 patients were evaluated, with a median age of 67 years old (60–89). The overall 3-month mortality of elderly patients admitted to the ED was 32.5%. The independent predictors of 3-month mortality obtained from the multivariate analysis were functional status decline (odds ratio [OR]: 3.05; 95% confidence interval [CI]: 1.63–5.73), polypharmacy (OR: 2.65; 95% CI: 1.74–4.04), delirium (OR: 2.01; 95% CI: 1.26–3.21), and hypoalbuminemia (OR: 1.89; 95% CI: 1.02–3.50). Conclusion: Functional status decline, polypharmacy, delirium, and hypoalbuminemia are independent predictors of 3-month mortality among elderly patients in the ED.

Disaster preparedness among Thai elderly emergency department patients: a survey of patients\u2019 perspective

BackgroundIn disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness.MethodsThis study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB).ResultsA total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66–81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations.ConclusionsWhile most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

Comparison of clinical presentations and outcomes between adult and elderly acute myocardial infarction patients in emergency department

Background: Acute myocardial infarction (AMI) is one of a leading cause of death. The clinical presentations and outcomes between adults and elderly were still not well established. Methods: We conducted a prospective study to evaluate the clinical manifestations of AMI at emergency department in Taiwan. Patients with unstable angina were excluded. The primary endpoint was all-cause mortality. The inpatient days, discharge activities, complications were collected for comparisons. Results: Overall 210 consecutive cases with acute coronary syndrome were recruited in ER, 202 patients with AMI were enrolled for further analysis (66.3% STEMI and 33.7% NSTEMI). Among all AMI patients, 57 patients (28.2%) aged more than 65 years old. The overall inpatient days and total complications were not significantly different between adult and elderly patients. However, K-M survival analysis displayed that patients over the age of 75 years old was with poor event free survival rate of mortality (Log-rank test, P=0.03), especially for those patients with STEMI (Log-rank test, P=0.01). Cox regression exhibited that chest X-ray finding of cardiomegaly [adjusted hazard ratio (HR), 95% confidence interval (CI): 13.5, 1.27–144, P=0.03] and peak CK-MB levels (adjusted HR, 95% CI: 1.003, 1.001–1.004, P Conclusions: The clinical presentations and outcomes may vary among adult AMI patients and older AMI patients. The chest X-ray finding of cardiomegaly and higher peak CK-MB levels may predict future mortality in AMI patients. The elderly patients over 75 years were with higher mortality after onset of AMI.

Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study.

To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department. The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR). A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224). Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.