Management of very elderly patients in the emergency room: assessment of care in 150 patients

OBJECTIVES: There are few data in the literature concerning care provided t o very elderly subjects referred to emergency care units. The emergency roo m setting would not be particularly adapted to management of this rising po pulation. The purpose of our work was to assess the frequency of referral t o emergency care units, the characteristics of the elderly population, and patient management. PATIENTS AND METHODS: One hundred fifty consecutive patients aged over 90 y ears addressed to the emergency unit of the Charles Nicolle hospital in Rou en France were studied. These patients were cared for by the medical and su rgical teams. We recorded, type of referral, hour and reason for admission, degree of handicap and residence, gravity at admission using the clinical classification for emergency care patients (CCMU), complementary tests perf ormed in the emergency unit duration of stay in the unit and subsequent ref erral. The characteristics of these "very" elderly patients aged over 90 ye ars were compared with those of "elderly" patients aged 75-90 years. RESULTS: Over a period of 33 days, the unit cared for 4888 patients, includ ing 150 very elderly patients aged over 90 years (mean age 92.6 years). Dai ly, 4.4 patients were referred by a primary care physician (76.), mainly be tween 8 a.m. and 8 p.m. (81.3%). Forty-two percent of the patients had a su rgical problem. Two-thirds were unable to walk, one-third had cognitive dis orders, and one-third had urinary incontinence. However, half of these very elderly patients lived in a private home. According to the CCMU classifica tion, 14.6% of the patients had a life-threatening disorder. Complementary tests were ordered for most patients (85%). Mean duration of stay in the em ergency unit was 3.6 +/- 2.6 days. One quarter of the patients returned to their former residence, with a higher percentage among the surgery patients (37%) than among the medical patients (14.6%). There was no significant di fference between the "very elderly" and "elderly" patients in terms of type of referral, duration of stay in the unit and subsequent referral. CONCLUSION: "Very elderly" patients are frequently addressed to emergency c are units by their primary care physician. They have severe conditions with major handicaps that largely explain their hospitalization. Our results po int out possible improvements for care in the emergency unit.