Elderly patients in the emergency department: a prospective study of characteristics and outcome

Abstract

Objective: To describe the characteristics of elderly patients presenting to an emergency department and the outcome for these patients at 90 days.

Design: Prospective, descriptive study of all patients over 75 years of age presenting in a four week period. Follow-up data were obtained from the case notes, the Registry of Deaths, the Geriatric Assessment Team and, where necessary, contact with the family doctor.

Setting: The Department of Emergency Medicine at the Royal Hobart Hospital, Tasmania, in late 1989.

Main outcome measures: Death or increased dependence as defined by permanent institutionalisation, moving in with family, or more than 90 days inpatient care.

Results: There were 210 presentations by 191 different patients; 116 were admitted to our hospital (55.2%), and three (1.4%) to other hospitals. Follow-up data were obtained for all but five patients. At 90 days from first presentation 23 had died (12.4%) and in a further 19 (10.2%) their dependence had increased. Risk factors for death were fractured neck of femur or cardiac failure. Risk factors for either death or increased dependence were referral by someone outside the immediate family, neurological disease, cardiac failure, an apparent social/placement problem, and being assessed as needing admission. The strongest predictor was a social problem. Age was not a risk factor.

Conclusions: A predictive formula for poor outcome in this group can be derived. However, outcome may not be altered by admission, or intervention. In the elderly, it is quality rather than duration of life which should be paramount in considering the benefits of therapy.