Aging Clinical and Experimental Research

, Volume 25, Issue 5, pp 583–590 | Cite as

Pattern of use and presenting complaints of older patients visiting an Emergency Department in Italy

  • Fabio Salvi
  • Annalisa Mattioli
  • Elena Giannini
  • Diego Vita
  • Valeria Morichi
  • Mauro Fallani
  • Paolo Dessì-Fulgheri
  • Antonio Cherubini
Original Article

Abstract

Background and aims

The number of older persons admitted to the Emergency Department (ED) is dramatically increasing due to their complex medical and social problems, which in turn lead to longer clinical evaluation times and increased use of resources compared to younger adults. However, scant data are available for Italian EDs. Similarly, no data are available about the reasons to ED visit and its role in determining the ED utilization pattern. The study aimed at describing the pattern of ED use by older patients and main presenting complaints.

Methods

Cross-sectional descriptive study of 5,826 ED patients in the city of Fano (Italy). Identifiers and triage, clinical and social data were collected. Presenting complaints as recorded by triage nurses have been recoded according to the Canadian Emergency Department Information System list version 1.1. Data were analyzed comparing older patients (more than 65 years-old) with younger adults (less than 65 years-old).

Results

The prevalence of ED visits by older adults was 23.9 %. Their visits were characterized by higher emergency levels, admission rate and length of ED stay. Trauma was the main reason for ED presentation, especially among young adults, but elderly trauma patients were more frequently admitted because of hip fracture. Dyspnea and abdominal pain were the most frequent non-trauma presenting complaints among geriatric patients and represented the main causes for admission.

Conclusions

Older adults use the ED appropriately also in Italy. Trauma with complications (fracture) and various presenting complaints underlying medical problems accounted for more than 50 % of ED visits and hospital admissions.

Keywords

Emergency department Older adult Presenting complaints 

References

  1. 1.
    Pitts SR, Niska RW, Xu J, Burt CW (2008) National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report 7:1–38PubMedGoogle Scholar
  2. 2.
    Roberts DC, McKay MP, Shaffer A (2008) Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 51:769–774PubMedCrossRefGoogle Scholar
  3. 3.
    Aminzadeh F, Dalziel WB (2002) Older adults in the Emergency Department: a systematic review of pattern of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 39:238–247PubMedCrossRefGoogle Scholar
  4. 4.
    Wolinsky FD, Liu L, Miller TR et al (2008) Emergency department utilization patterns among older adults. J Gerontol A Biol Sci Med Sci 63:204–209PubMedCrossRefGoogle Scholar
  5. 5.
    Green SM (2012) Emergency department patient acuity varies by age. Ann Emerg Med 60:147–151PubMedCrossRefGoogle Scholar
  6. 6.
    Khan SA, Miskelly FG, Platt JS, Bhattachryya BK (1996) Missed diagnoses among elderly patients discharged from an accident and emergency department. J Accid Emerg Med 13:256–257PubMedCrossRefGoogle Scholar
  7. 7.
    Jarrett PG, Rockwood K, Carver D et al (1995) Illness presentation in elderly patients. Arch Intern Med 155:1060–1064PubMedCrossRefGoogle Scholar
  8. 8.
    Sklar DP, Crandall CS, Loeliger E et al (2007) Unanticipated death after discharge home from the Emergency Department. Ann Emerg Med 49:735–745PubMedCrossRefGoogle Scholar
  9. 9.
  10. 10.
    Conferenza permanente per i rapporti tra lo stato, le regioni e le province autonome di Trento e Bolzano. Accordo 25 ottobre 2001. GURI n. 285 del 7 dicembre 2001. http://www.salute.gov.it/imgs/C_17_normativa_1747_allegato.pdf. Accessed 2 Aug 2013
  11. 11.
    Grafstein E, Bullard MJ, Warren D, Unger B; the CTAS National Working Group (2008) Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List Version 1.1. CJEM 10:151–161Google Scholar
  12. 12.
    Grafstein E, Unger B, Bullard M, Innes G; for the Canadian Emergency Department Information System (CEDIS) Working Group (2003) Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (Version 1.0). CJEM 5:27–34Google Scholar
  13. 13.
    Salvi F, Morichi V, Grilli A et al (2007) The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med 2:292–301PubMedCrossRefGoogle Scholar
  14. 14.
    Samaras N, Chevalley T, Samaras D, Gold G (2010) Older patients in the Emergency Department: a review. Ann Emerg Med 56:261–269PubMedCrossRefGoogle Scholar
  15. 15.
    Grunei A, Silver MJ, Rochon PA (2011) Emergency Department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev 68:131–155CrossRefGoogle Scholar
  16. 16.
    Yim VW, Graham CA, Rainer TH (2009) A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong. Int J Emerg Med 2:19–24PubMedCrossRefGoogle Scholar
  17. 17.
    Foo CL, Chan KC, Goh HK, Seow E (2009) Profiling acute presenting symptoms of geriatric patients attending an urban hospital emergency department. Ann Acad Med Singapore 38:515–520PubMedGoogle Scholar
  18. 18.
    Niska R, Bhuiya F, Xu J (2010) National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report 26:1–31PubMedGoogle Scholar
  19. 19.
    Downing A, Wilson RC, Cooke MW (2004) Which patients spend more than 4 hours in the Accident and Emergency Department? J Public Health (Oxf) 26:172–176CrossRefGoogle Scholar
  20. 20.
    Rossi PD, Bergamaschini L, Bilotta C et al (2010) Age and time spent in the emergency department of an urban teaching hospital in Italy. J Am Geriatr Soc 58:2030–2032 (Letter)PubMedCrossRefGoogle Scholar
  21. 21.
    Castronuovo E, Pezzetti P, Franzo A et al (2011) Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr 11:37PubMedCrossRefGoogle Scholar
  22. 22.
    Carpenter CR, Stern ME (2010) Emergency orthogeriatrics: concepts and therapeutic alternatives. Emerg Med Clin N Am 28:927–949CrossRefGoogle Scholar
  23. 23.
    Close JC, Lord SR, Antonova EJ et al (2012) Older people presenting to the emergency department after a fall: a population with substantial recurrent healthcare use. Emerg Med J 29:742–747PubMedCrossRefGoogle Scholar
  24. 24.
    McD Taylor D, Bennet DM, Cameron PA (2004) A paradigm shift in the nature of care provision in emergency departments. Emerg Med J 21:681–684PubMedCrossRefGoogle Scholar
  25. 25.
    Pines JM, Mullins PM, Cooper JK et al (2013) National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc 61:12–17PubMedCrossRefGoogle Scholar
  26. 26.
    Ellis G, Whitehead MA, Robinson D et al (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553. doi:10.1136/bmj.d6553 PubMedCrossRefGoogle Scholar
  27. 27.
    Di Bari M, Balzi D, Roberts AT et al (2010) Prognostic stratification of older persons based on simple administrative data: development and validation of the “Silver Code”, to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 65:159–164PubMedCrossRefGoogle Scholar
  28. 28.
    Elie M, Rousseau F, Cole M et al (2000) Prevalence and detection of delirium in elderly emergency department patients. CMAJ 163:977–981PubMedGoogle Scholar
  29. 29.
    Han JH, Zimmerman EE, Cutler N et al (2009) Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med 16:193–200PubMedCrossRefGoogle Scholar
  30. 30.
    Kakuma R, du Fort GG, Arsenault L et al (2003) Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc 51:443–450PubMedCrossRefGoogle Scholar
  31. 31.
    Thompson DA, Eitel D, Fernandes CM et al (2006) Coded chief complaints-automated analysis of free-text complaints. Acad Emerg Med 13:774–782PubMedGoogle Scholar
  32. 32.
    Aronsky D, Kendall D, Merkley K et al (2001) A comprehensive set of coded chief complaints for emergency department. Acad Emerg Med 8:980–989PubMedCrossRefGoogle Scholar
  33. 33.
    Salvi F, Morichi V, Grilli A et al (2008) A geriatric emergency service for acutely ill elderly patients: pattern of use and comparison with a conventional emergency department in Italy. J Am Geriatr Soc 56:2131–2138PubMedCrossRefGoogle Scholar
  34. 34.
    Ballabio C, Bergamaschini L, Mauri S et al (2008) A comprehensive evaluation of elderly people discharged from an Emergency Department. Intern Emerg Med 3:245–249PubMedCrossRefGoogle Scholar
  35. 35.
    McCusker J, Verdon J (2006) Do geriatric interventions reduce emergency department visits? A systematic review. J Gerontol A Biol Sci Med Sci 61A:53–62CrossRefGoogle Scholar
  36. 36.
    Hwang U, Morrison RS (2007) The geriatric emergency department. J Am Geriatr Soc 55:1873–1876PubMedCrossRefGoogle Scholar
  37. 37.
    McCusker J, Verdon J, Vadeboncoeur A et al (2012) The elder-friendly emergency department assessment tool: development of a quality assessment tool for emergency department-based geriatric care. J Am Geriatr Soc 60:1534–1539PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Fabio Salvi
    • 1
    • 5
  • Annalisa Mattioli
    • 2
  • Elena Giannini
    • 2
  • Diego Vita
    • 3
  • Valeria Morichi
    • 1
  • Mauro Fallani
    • 3
  • Paolo Dessì-Fulgheri
    • 2
  • Antonio Cherubini
    • 1
    • 4
  1. 1.Department of Geriatrics and Emergency CareItalian National Research Centres on Aging (I.N.R.C.A.)AnconaItaly
  2. 2.Department of Internal Medicine and GeriatricsItalian National Research Centres on Aging (I.N.R.C.A.) and University Politecnica delle MarcheAnconaItaly
  3. 3.Emergency DepartmentAzienda ospedaliera “Ospedali Riuniti Marche Nord”FanoItaly
  4. 4.Institute of Gerontology and GeriatricsUniversity of PerugiaPerugiaItaly
  5. 5.Geriatric Emergency DepartmentI.N.R.C.A., POR AnconaAnconaItaly

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