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. 2019 Feb 27;19(1):20.
doi: 10.1186/s12873-019-0236-3.

Emergency department visits in older patients: a population-based survey

Mika Ukkonen  1   2 , Esa Jämsen  3   4 , Rainer Zeitlin  5 , Satu-Liisa Pauniaho  6
Affiliations

Emergency department visits in older patients: a population-based survey

Mika Ukkonen et al. BMC Emerg Med. .

Abstract

Background: Given the higher incidence of emergency conditions in older inhabitants, the global increase in aged population will pose a challenge for emergency services. In this study we examined the burden caused to emergency health care by the aged population.

Methods: Consecutive patients aged 80 years or over visiting a high-volume, collaborative emergency department (ED) between 2015 and 2016 were included. The key factors under analysis were the incidence of emergency conditions and costs associated with emergency care.

Results: A total of 6944 patients (median age 85 years, range 80-104 years; 67% female) aged ≥80 years representing 1.5% of the local population, made 17,769 ED visits during the two-year observation period accounting for 15% of all ED visits. Forty-two percent (n = 2884) of patients had a single ED visit, whereas 8.2% (n = 570) made ≥5 ED visits/year for a total of 1400 visits (7.9%). Thirty-two percent of those aged ≥80 years required ED services each year. The number of ED visits increased with age (p < 0.001); and was 768/1000 person-years among octogenarians and 1007/1000 among nonagenarians, in comparison to 233/1000 among those aged < 80 years. One in five of the study population were discharged with non-specific diagnoses. Typical diagnoses included pneumonia (4.8%), malaise and fatigue (4.5%) and heart failure (4.3%). Non-specific diagnoses were frequent, and examination of patients with non-specific diagnoses incurred costs similar to or higher than those of other patients. The mean cost per ED visit in older patients was 422 €.

Conclusions: We demonstrated a high incidence of emergency department visits in older patients. While our aim was not to solve how the growing demand should be met, it seems unlikely that increasing ED resources is feasible. Instead, the focus should be on chronic care of the aged and prevention of potentially avoidable ED visits.

Keywords: Aged; Emergencies; Epidemiology; Health care costs.

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Conflict of interest statement

Authors’ information

Mika Ukkonen, MD, PhD, M.Econ, is a specialist in surgery of the alimentary tract. As a master of economic sciences he has a special interest in health economics.

Esa Jämsen, MD, PhD, is acting professor of Geriatrics at Tampere University, and vice-chair of the Finnish Society for Geriatric Emergency Medicine. His research interests are related to acute and hospital care of the aged.

Rainer Zeitlin, MD, PhD, is the head of Sastamala Hospital in Pirkanmaa Hospital district which is a hospital focusing on rehabilitation, especially in older patients.

Satu-Liisa Pauniaho, MD, PhD, is the head of emergency department of Tampere University hospital. Her interests focus on the burden, costs and patient flow in the emergency department.

Ethics approval and consent to participate

This was a retrospective, register-based study, and none of the patients were contacted. Hence, Ethics approval was not applied for. According to Finnish and European Union Legislation ethics approval or consent to participate are not required in this kind of study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Population size adjusted number of those requiring ED care (number of patients admitted to ED/1000 same aged inhabitants/year) in different age (patients aged 80 years or over)
Fig. 2
Fig. 2
Age- and gender adjusted incidence of emergency department visits (total number of visits/1000 same aged inhabitants/year) among older inhabitants (aged 80 years or over)
Fig. 3
Fig. 3
Mean public costs to the public (euros) per emergency department visits of older patients (aged≥80 years) in different patient populations
Fig. 4
Fig. 4
Estimated annual number of emergency visits within our hospital district based on age and gender-adjusted incidence (number of admissions per 1000 same-aged inhabitants) and population projections by Statistics Finland [2] (years 2017 to 2040)
See this image and copyright information in PMC

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References

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