Elderly patients with an atypical presentation of illness in the emergency department

Abstract

Background: Very little information is available on the prevalence and clinical outcome of elderly patients with atypical presentations of illness in the emergency department. The objective was to determine the prevalence and clinical outcome of elderly patients seen in the emergency department with an atypical presentation.

Methods: A monocentric retrospective observational study on 355 elderly patients presenting to the emergency department. Patients of 80 years and older were included. Data were extracted from the electronic medical file.

Results: A total of 355 patients were included, with a mean age of 86 years; 53% of these elderly patients had an atypical presentation of illness. Mostly this was due to a fall (71%). A total of 15% of the patients with an atypical presentation reported no specific symptoms of the underlying disease. Patients with atypical presentation were more likely to have a longer stay in hospital (p < 0.001), to be discharged to a care institution (p = 0.000), and to have a higher delirium observation score (p < 0.001). There was no significant difference in one-year survival (p = 0.056).

Conclusion: Atypical presentation of illness in elderly patients is highly prevalent in the emergency department. Falling accidents are the most important reason for this. Patients with an atypical presentation have a worse clinical outcome. Accurate training of emergency staff is necessary to recognise this group of patients to ensure proper clinical monitoring and timely treatment.