Abstract
Objectives
The ageing population implicates an increasing numbers of older adults attending Emergency Departments (ED). We assessed the effect of estimated glomerular filtration rate as a predictor of clinical outcomes in oldest-old patients ≥ 85 years attending the ED in an university teaching hospital.
Design
Within three years, 81831 patient contacts were made in our ED. 7799 (9.5%) were older than 85 years, in whom we analyzed the impact of renal function on various outcome parameters. Furthermore, this patient group was compared to the patients > 85 years.
Results
Within the group of patients ≥ 85 years, not older age, but as denominator decreased glomerular filtration rate led to significant longer hospital stays. In addition, impaired kidney function was associated with lower heart rates, lower blood pressure, lower oxygenation, a higher rate of established ambulant care setting, as well as higher mortality. Compared to younger patients, the oldest-old significantly differed with regard to medical attribution (e.g. internal medicine, surgery), sex distribution, length of hospital stay, Manchester triage score, Glasgow Coma Scale, visual analogue pain scale, heart rate, blood pressure, oxygen saturation as well as fall prophylaxis, outpatient care, and presence of relatives.
Conclusion
In conclusion, in this large collective of oldest-old patients, impaired kidney function seems to be a more important determinant in adverse outcome and thus increased health care costs than age per se. Adapted strategies in EDs to adjust diagnostic and treatment strategies for this population are thus warranted.
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References
EC. The 2012 Ageing Report. http://eceuropaeu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en pdf 2014 October 20
Chenore T, Pereira Gray DJ, Forrer J, Wright C, Evans PH. Emergency hospital admissions for the elderly: insights from the Devon Predictive Model. J Public Health (Oxf) 2013;35(4):616–23.
Romero-Ortuno R, Silke B. Use of a laboratory only score system to define trajectories and outcomes of older people admitted to the acute hospital as medical emergencies. Geriatr Gerontol Int 2013;13(2):405–12.
Underwood F, Burnett W. Frail older people and emergency care. Nurs Older People 2012;24(1):13.
Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011;343:d6553.
Conroy SP, Ansari K, Williams M, Laithwaite E, Teasdale B, Dawson J, et al. A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’. Age Ageing 2014;43(1):109–14.
Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly 2005;5;135(9-10):145–50.
Tonelli M, Riella M. Chronic kidney disease and the aging population. Int J Organ Transplant Med 2014;5(1):1–6.
Robles NR, Felix FJ, Lozano L, Miranda I, Fernandez-Berges D, Macias JF. The H.U.G.E. Formula (Hematocrit, Urea, Sex) for Screening Chronic Kidney Disease (CKD) in an Age-Stratified General Population. J Nutr Health Aging 2015;19(6):688–92.
Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80(12):1258–70.
Smyth A, Glynn LG, Murphy AW, Mulqueen J, Canavan M, Reddan DN, et al. Mild chronic kidney disease and functional impairment in community-dwelling older adults. Age Ageing 2013;42(4):488–94.
Depp CA, Glatt SJ, Jeste DV. Recent advances in research on successful or healthy aging. Curr Psychiatry Rep 9(1):7-13.
Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol 2013;24(3):337–51.
Damman K, Valente MA, Voors AA, O’Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 2014;35(7):455–69.
Di LL, House A, Gorini A, Santoboni A, Russo D, Ronco C. Chronic kidney disease and cardiovascular complications. Heart Fail Rev 2015;20(3):259–72.
de BP, Mahmoudi R, Hentzien M, Toquet S, Novella JL, Blanchard F, et al. Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort. J Nutr Health Aging 2015;19(6):702–7.
Azeredo TR, Guedes HM, Rebelo de Almeida RA, Chianca TC, Martins JC. Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2(7872):81–4.
Joyce CR, Zutshi DW, Hrubes V, Mason RM. Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 1975;8(6):415–20.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604–12.
Hildreth KL, Church S. Evaluation and management of the elderly patient presenting with cognitive complaints. Med Clin North Am 2015;99(2):311–35.
Zhang QL, Koenig W, Raum E, Stegmaier C, Brenner H, Rothenbacher D. Epidemiology of chronic kidney disease: results from a population of older adults in Germany. Prev Med 2009;48(2):122–7.
Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158(11):825–30.
Smyth A, Glynn LG, Murphy AW, Mulqueen J, Canavan M, Reddan DN, et al. Mild chronic kidney disease and functional impairment in community-dwelling older adults. Age Ageing 2013;42(4):488–94.
Kilbride HS, Stevens PE, Eaglestone G, Knight S, Carter JL, Delaney MP, et al. Accuracy of the MDRD (Modification of Diet in Renal Disease) studyand CKD-EPI (CKD Epidemiology Collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis 2013;61(1):57–66.
Martus P, Ebert N, van der Giet M, Jakob O, Schaeffner ES. An efficient approach for glomerular filtration rate assessment in older adults. Br J Clin Pharmacol, 2014
Gill TM, Allore HG, Gahbauer EA, Murphy TE. Change in disability after hospitalization or restricted activity in older persons. JAMA 2010;304(17):1919–28.
Flood KL, Maclennan PA, McGrew D, Green D, Dodd C, Brown CJ. Effects of an acute care for elders unit on costs and 30-day readmissions. JAMA Intern Med 2013;173(11):981–7.
Sogaard M, Schonheyder HC, Riis A, Sorensen HT, Norgaard M. Short-term mortality in relation to age and comorbidity in older adults with community-acquired bacteremia: a population-based cohort study. J Am Geriatr Soc 2008;56(9):1593–600.
Lowenstein SR, Crescenzi CA, Kern DC, Steel K. Care of the elderly in the emergency department. Ann Emerg Med 1986;15(5):528–35.
Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA 2010;303(5):423–9.
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Brünnler, T., Drey, M., Dirrigl, G. et al. The oldest old in the Emergency Department: Impact of renal function. J Nutr Health Aging 20, 1045–1050 (2016). https://doi.org/10.1007/s12603-016-0731-0
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DOI: https://doi.org/10.1007/s12603-016-0731-0