Retrospective Analysis of the Oldest-Old Patients Who Applied to the Emergency Department and Their Differences from the Young-Old And Middle-Old

Year 2023, Volume: 6 Issue: 1, 20 - 24, 08.03.2023

İbrahim Toker , Ayşin Kılınç Toker , İrfan Gökçek , Emre Bulbul , Gökhan Yılmaz , Mustafa Silcan , Şaban Irmak , Mükerrem Altuntaş

https://doi.org/10.54996/anatolianjem.1119584

Abstract

Aim: Our study examined young, middle, and oldest-old patients who visited the emergency department (ED) and their differences.

Material and Methods: The research was executed retrospectively, utilizing the medical data of patients aged 65 and over who applied to the ED of a research hospital in Kayseri for the two years between January 1, 2020, and December 31, 2021. The patients were young-old, between 65 and 74 years old; aged 75 to 84 were middle-old, and those aged 85 and over were classified as oldest-old.

Results: 84415 (13.7%) older patients visited the ED during the study period. The patients’ median age was 74 years, IQRs (69- 80) and 53.9% (n=45466) were female. 53.4% of the patients were young-old, 33.4% middle-old, and 13.2% were oldest-old. 7.2% (n=6060) of the hospitalized patients were admitted to the intensive care unit, and 7.8% (n=1719) died. Among the first three reasons for admitting the patients to the ED, 20% (n=16874) had COVID-19, 14.4% (n=12131) had gastrointestinal symptoms, and 13.9% (n=11718) had circulatory system symptoms. Oldest-old patients were brought to the ED by ambulance more (38.4% vs. 50.9% vs. 63.2% p< 0.001), stayed longer in the ED (81 vs. 103 vs. 116 minutes, p<0.001), fewer discharged (76.2% vs. 69.5% vs. 66%, p<0.001) and a higher in-hospital mortality rate (6% vs. 8.1% vs. 12.4% p<0.001).

Conclusıon: We found that the length of stay in the ED, hospitalization rate, and ED and hospital mortality increased with age and were higher in oldest-old patients. We think that emergency health services should be developed according to the groups of elderly patients.

Keywords

Aged, patient outcome assessment, emergency medicine

Acil Servise Başvuran İleri-Yaşlı Hastaların Retrospektif Analizi ve Genç-Yaşlı ve Orta-Yaşlılardan Farklılıkları

Abstract

Amaç: Çalışmamızda acil servise (AS) başvuran genç, orta ve ileri yaşlı hastaları ve farklılıklarını incelemeyi amaçladık.

Gereç ve Yöntemler: Çalışma 1 Ocak 2020 ile 31 Aralık 2021 arasındaki 2 yıllık dönemde Kayseri'de bir araştırma hastanesinin AS’ e başvuran 65 yaş ve üzeri hastaların tıbbi kayıtları kullanılarak geriye dönük olarak yapıldı. Hastalar 65 ile 74 yaş arasında genç-yaşlı; yaşları 75 ile 84 arasında olanlar orta yaşlı; 85 yaş ve üzerinde olanlar ileri-yaşlı olarak sınıflandırıldı.

Bulgular: Çalışma süresi boyunca 84.415 (%13,7) yaşlı hasta AS’ e başvurdu. Hastaların yaş ortancası 74 yıl, ÇAA (69- 80) ve %53.9’ u (n=45466) kadındı. Hastaların %53,4’ ü genç-yaşlı, %33,4 orta-yaşlı ve %13,2’ si ileri-yaşlı idi. Hastaneye yatan hastaların %7,2’ sinin (n=6060) yoğun bakıma yattığı ve %7,8’ inin (n=1719) öldüğü tespit edildi. Hastaların acil servise başvuru nedenlerinde ilk üç sırada %20 ile (n=16874) COVID-19, %14,4’ ünün (n=12131) ile gastrointestinal sistem, %13,9 ile (n=11718) dolaşım sistemi semptomları vardı. İleri-yaşlı hastaların AS’ e daha fazla ambulans ile geldiği (%38,4 vs %50,9 vs % 63,2 p<0,001), AS’ de daha uzun süre kaldığı (81 vs 103 vs 116 dakika, p<0.001), daha az taburcu edildiği (%76,2 vs %69,5 vs %66, p<0.001) ve hastane içi ölüm oranın daha fazla olduğu (%6 vs %8,1 vs %12,4 p<0.001) bulundu.

Sonuç: AS kalış süresi, hastaneye yatış oranı ve AS ve hastane mortalitesinin yaşla birlikte arttığını ve ileri-yaşlı hastalarda daha yüksek olduğunu bulduk. Acil sağlık hizmetlerinin yaşlı hasta gruplarına göre geliştirilmesi gerektiğini düşünüyoruz.

Keywords

Yaşlı, hasta sonuçlarının değerlendirilmesi, acil tıp

References

• Smith D. The Older Population in the United States: March 2002. Current Population Reports. U.S. Department of Commerce Economics and Statistics Administration. U.S. CENSUS BUREAU. 2003
• Türkiye İstatistik Kurumu. İstatistiklerle Yaşlılar 2016, Sayı: 24644. TÜİK., 2017.
• Müller M, Ricklin ME, Weiler S, et al. Emergency medicine in the extreme geriatric era: A retrospective analysis of patients aged in their mid 90s and older in the emergency department. Geriatr Gerontol Int. 2018 Mar;18(3):415–20.
• Vilpert S, Ruedin HJ, Trueb L, Monod-Zorzi S, Yersin B, Büla C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital. BMC Health Serv Res. 2013 September 8;13:344.
• Lee SB, Oh JH, Park JH, et al. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med. 2018 Dec;5(4):249–55.
• OECD (2022), Elderly population (indicator). doi: 10.1787/8d805ea1-en (Accessed on 18 March 2022)
• Ashman JJ, Schappert SM, Santo L. Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014-2017. NCHS Data Brief. 2020 Jun;(367):1–8.
• Bardin A, Buja A, Barbiellini Amidei C, et al. Elderly People's Access to Emergency Departments during the COVID-19 Pandemic: Results from a Large Population-Based Study in Italy. J Clin Med. 2021 November 26;10(23):5563.
• Westgard BC, Morgan MW, Vazquez-Benitez G, et al. An Analysis of Changes in Emergency Department Visits After a State Declaration During the Time of COVID-19. Ann Emerg Med. 2020 Nov;76(5):595–601.
• Wyatt S, Mohammed MA, Fisher E, et al. Impact of the SARS-CoV-2 pandemic and associated lockdown measures on attendances at emergency departments in English hospitals: A retrospective database study. Lancet Reg Health Eur. 2021 Mar;2:100034.
• Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002 Mar;39(3):238–47.
• Samaras N, Chevalley T, Samaras D, et al. Older patients in the emergency department: a review. Ann Emerg Med. 2010 Sep;56(3):261–9.
• Jungeun L, Jia L. Factors Associated with Mortality of Older Adults Hospitalized via Emergency Departments in Korea. Korean J Adult Nurs. 2020 June 1;32:273–82.
• Latham LP, Ackroyd-Stolarz S. Emergency department utilization by older adults: a descriptive study. Can Geriatr J CGJ. 2014 Dec;17(4):118–25.
• Hooker EA, Mallow PJ, Oglesby MM. Characteristics and Trends of Emergency Department Visits in the United States (2010-2014). J Emerg Med. 2019 Mar;56(3):344–51.
• Mushtaq S, Abro MT, Sualeh M, et al. Profile of Geriatric Patients Attending the Emergency Department of a Tertiary Care Hospital in Karachi: A Cross-Sectional Study. Cureus. 2022;14(2):e21874.
• Ergi̇n M, Karamercan MA, Ayranci M, et al. Epidemiological Characteristics Of Geriatric Patients In Emergency Departments: Results Of A Multicenter Study. Türk Geriatri Derg. 2015;18(4):259–65.