An observational cohort study on geriatric patient profile in an emergency department in the Netherlands

Abstract

Background: Currently, Dutch emergency care systems focus on rapid emergency department (ED) patient management with short completion times, which may not meet specific geriatric care needs.

Methods: Six-week observational study in patients aged ≥70 years, attending the ED of VU University Medical Center (VUmc, Amsterdam, the Netherlands) during weekday peak presentation times (10 AM - 10 PM).

Results: During six weeks, a total of 183 patients aged ≥70 years attended the ED, of which 117 (63.9%) presented during weekday peak hours. One hundred patients with a median age of 81 (min-max; 70-97 years) were prospectively observed. The majority presented with fall-related complaints (30%), multiple comorbidities (≥3 in 50.0%) and polymedication (≥5 in 53.7%). Mean ED length of stay was 175.8 (range 20-399) minutes (n=98). Of the patients discharged to their usual residence prior to the ED visit (n=58), 36.2% returned to our ED within 30 days; one in five of these patients had initially presented with a fall.

Conclusion: In this study, fall-related injuries were the most frequent presenting complaint during weekday peak presentation times in 70-plus patients. Of these, one in five discharged from the ED returned within 30 days. Our emergency care system may not adequately cover comprehensive ED geriatric assessment, or provide sufficient outpatient care after ED home discharge. We believe that EPs should be more aware of the complex problems encountered in acute geriatric patients and address follow-up care pathways such as geriatric outpatient services, more often in frail elderly patients discharged home.