Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care

Publisher Website
Google Scholar
Abstract
Little is known about how the care received in emergency departments (ED) by the elderly population differs from that received by younger people. We prospectively abstracted ED records of 1620 consecutive patients visiting a large community hospital ED over a 22-day period in 1984 for demographic and medical variables. Charts of patients presenting with five specific complaints (dyspnea, chest pain, abdominal pain, syncope, and motor vehicle accidents) were also analyzed for process of care variables and, for patients hospitalized, the accuracy of the ED diagnosis. Older people (ie, those .gtoreq. 65 years of age) do not seem to be overutilizers of the ED for minor complaints, in fact, they tend to be more acutely ill on presentation than younger people. Older people were more likely to be hospitalized (46% v 10%, P < .001), to arrive by ambulance (35% v 10%, P < .001), and to have an identified source of primary care (95% v 64%, P < .01). Older people stayed longer in the ED than younger people if they were eventually released home but shorter if admitted to the hosptial. Test ordering patterns for specific complaints varied by patient age (eg, older patients had more electrocardiograms performed for chest pain and fewer urinalyses for abdominal pain than younger patients). Therapy for specifc complaints showed less age effect. Although generally more diagnostic tests were performed on older patients, the ED diagnosis tended to be more accurate for younger patients. Our data indicate that the process of ED care may be substantially different for the elderly population and have implications for future planning and financing of medical care.