Senior Care in the ER

Senior patients may need extra special care in the ER

(RxWiki News) A visit to the emergency room (ER) can be overwhelming for anyone. For senior patients, especially those who already need help from a caretaker, a visit to the ER can be overwhelming and quite risky.

In a recent study, researchers followed a group of senior patients through a visit to the emergency department.

The researchers found that the majority of senior patients had at least one symptom of aging, such as falling or trouble thinking, remembering or walking, which could put them at risk for complications in the emergency department.

"Make sure your elderly relatives get proper medical care."

Leonard C. Gray, MD, PhD, of the Centre for Research in Geriatric Medicine at the University of Queensland in Brisbane, Australia, led this study into care specific to aging individuals, also known as geriatric care, during emergency department visits.

According to the authors, use of the emergency department by patients 75 years of age and older has increased over the years. These senior patients have been more likely to have multiple diseases or long-term illness, and therefore have had more trouble with physical and mental functioning and limited social support compared to younger patients.

Previous research has shown that senior patients have a higher rate of missed diagnosis of an illness, return visits to the emergency department after discharge, prescription medication errors and bad reactions to medications compared to younger patients with the same type and severity of illness.

For this study, the researchers evaluated 2,282 patients, 75 years of age and older, from 13 different emergency departments located across Australia, Belgium, Canada, Germany, Iceland, India and Sweden.

The researchers discovered that before needing to go to the emergency department, 46 percent of these patients were dependent upon a caregiver of some sort for one or more aspects of their daily lives.

Roughly 40 percent needed help with bathing, 26 percent needed help with transportation and 20 percent needed help making daily decisions.

Once in the emergency department, 67 percent of these patients needed help from a caregiver of some sort, as 26 percent had trouble with thinking, memory and making decisions and 49 percent couldn’t walk without help.

Geriatric syndrome, classified as one or more medical issues related to aging, can include bladder control problems, dementia, falling, pressure ulcers (bed sores), hearing problems, vision problems and osteoporosis (weak bones), just to name a few.

The researchers found that 37 percent of the group had fallen recently.

Overall, at least 48 percent of these patients had one of the geriatric syndromes before needing to go to the emergency department. Once ill and in the emergency department, 78 percent of the patients had at least one geriatric syndrome.

After discharge, 18 percent of the patients returned to the emergency department within 28 days, and 12 percent had to be admitted to the hospital. Of the 18 percent that returned, 4 percent had returned to the emergency department more than once.

The researchers found no difference in the rates of geriatric syndromes between patients in the different nations.

The study authors concluded that geriatric syndromes affect the majority of senior patients over the age of 74, regardless of health system or cultural context.

The authors suggested emergency departments worldwide design clinical practices to properly care for geriatric patients.

"Our senior population represents one of the most difficult to treat in the ER. Patients often arrive with complicated medical histories, poor communication and comprehension, or unknown medical histories and no family to help with information," Chris Galloway, MD, told dailyRx. 

"As this study shows, ER patients 75 and older in many different countries often have cognitive and functional impairment at baseline.  These factors can contribute to our seniors presenting in a later stage of illness, and often more severe," said Dr. Galloway, who was not involved with this study.

"These patients require much more time and care as the potential for a missed diagnosis is high. These factors show a growing importance that ERs and hospitals adapt to the evolving needs of our aging population," he said.

This study was published in June in Annals of Emergency Medicine.

The Princess Alexandra Hospital Research Foundation, The Canadian Institutes of Health Research and the Bavarian Ministry of Environment and Health provided funding for this project. The authors declared no conflicts of interest.

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Review Date: 
June 27, 2013