Emergency departments drained of resources for elderly
medwireNews: Plans are needed to accommodate the growing demands on emergency departments (EDs) to provide suitable care for older individuals in the USA, say researchers.
Between 2001 and 2009, the annual number of adults aged 65 years or older who visited EDs increased by 25%, from 15.9 to 19.8 million, according to an analysis of data from the National Hospital Medical Care Survey.
Jesse Pines (George Washington University, District of Columbia, USA) and colleagues say one of the most significant findings of their analysis was the increased use of resources required for such visits. The proportion of individuals admitted to hospital increased by a significantly greater amount over the 9-year period than did the number treated and discharged, at 33% versus 20%, respectively.
In addition, admissions to intensive care units increased by 131%, strongly indicating higher rates of critical illness in this population.
Furthermore, the use of advanced imaging tests such as computed tomography and magnetic resonance imaging was substantially increased, by 167% and 85%, respectively, as was the use of laboratory tests such as cardiac monitoring, urinanalysis, electrocardiograms, and blood tests (by 79%, 87%, 43%, and 44%, respectively).
"It was not possible to assess whether increases in testing were evidence-based, although it does suggest an older, sicker population that is increasingly requiring more intense resources to manage health problems," say Pines and team. The findings may be a manifestation of improved technologies such as chemotherapy and transplantation, they suggest, as although life-prolonging, such technologies are also more resource-dependent in the event of complications or worsening of illness.
The researchers also report that there was little change in the types of symptoms older adults presented with on visiting EDs, with chest pain, shortness of breath, and abdominal pain being the three most common complaints. However, many of the most commonly reported symptoms were potentially serious and could represent life-threatening emergencies, they warn.
"Shifting many of these encounters to lower-resource primary care sites may not be possible… but several new care models such as the geriatric patient-centred medical home… and the Interventions to Reduce Acute Care Transfers program, may have the potential to alter the frequency of some lower-acuity ED visits or the number of return visits in the future," suggests the team.
"If changes in primary care do not affect these trends, facilities will need to plan to accommodate increasingly greater demands for ED and hospital services," they write in the Journal of the American Geriatrics Society.
By Sally Robertson, medwireNews Reporter