A 2-YEAR FOLLOW-UP OF GERIATRIC CONSULTS IN THE EMERGENCY DEPARTMENT

OBJECTIVE: To characterize the population and provide a 2-year follow- up for those patients for whom a geriatric consult was requested in th e emergency department (ED) of an acute care hospital. BACKGROUND: Old er people tend to use health services, including the ED, disproportion ately. This phenomenon has implications for medical services as the nu mber of older people continues to increase. To our knowledge, long-ter m follow-up of patients for whom ED geriatric consultation was request ed has not been described. SETTING: The emergency department of a 628- bed tertiary care university hospital in Montreal, Canada. SUBJECTS: 3 26 older patients examined in the ED by a geriatric consult team (GCT) . METHODS: The records kept by the GCT during a 12-month period were r eviewed retrospectively, and the patient cohort was followed for 2 yea rs by telephone or review of hospital charts. Mortality, rate of revis it to ED, readmission to hospital, and final disposition were examined . RESULTS: The study revealed a particularly high hospital admission r ate (63.5%) among those older people consulted by the GCT. The high pr e valence rates for the classic geriatric syndromes of falls, incontin ence, iatrogenic events, and confusional states suggest a need to addr ess these problems early in their presentation, preferably beginning i n the ED. A 2-year follow-up exhibited high mortality rates (33.7%) as well as a long-term institutionalization rate of 52%. CONCLUSION: The older patients seen in the ED of the acute care hospital for whom mul tidisciplinary geriatric consult is requested constitute a high-risk p opulation. Within 2 years after initial consultation, many are dead an d more than half have been institutionalized. The results of our follo w-up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow-up afte r hospital discharge.