Résumé
Les urgences représentent, en France, une autoroute d’accès aux soins pour les patients. Parmi eux, les patients âgés sont surreprésentés. Or, la médecine d’urgence des personnes âgées peut être difficile. Associant vulnérabilité liée à l’âge, pathologies sévères et polypathologie, elle se heurte aux difficultés liées aux conditions mêmes de l’urgence: manque de temps disponible pour reconstituer des situations complexes, pour contacter l’entourage et le médecin référent, pour reconnaître la pathologie en cause derrière l’atypie ou encore pour permettre un examen clinique exhaustif. Ainsi, le caractère d’urgence expose particulièrement les patients âgés à des difficultés dans la performance diagnostique autant qu’à un risque iatrogène qui se rencontre d’ailleurs durant tout le parcours de soins de ces patients vulnérables.
Abstract
In France, the emergency department provides a fast route for patients to gain access to care. Elderly patients are over-represented in this population. However, emergency medicine in the elderly can be difficult. Not only is there the combination of age-related vulnerability, severe disease and multiple pathology, but there is also a need to cope with problems that arise from the nature of the emergency department itself. Insufficient time is available to assess complex situations, to contact the family and the general practitioner, to recognise the disease underlying an atypical presentation and even to allow for a thorough clinical examination. Thus, the nature of the emergency department exposes the elderly patient, in particular, to problems of diagnostic accuracy, just as much as to the dangers of iatrogenicity, which are present throughout the care pathway in these vulnerable patients.
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Forest, A., Cohen-Bittan, J., Ray, P. et al. Difficultés de la prise en charge du patient âgé en médecine d’urgence. cah. année gerontol. 3, 43–47 (2011). https://doi.org/10.1007/s12612-011-0176-3
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DOI: https://doi.org/10.1007/s12612-011-0176-3