GERIATRIC-PATIENT EMERGENCY VISITS .1. COMPARISON OF VISITS BY GERIATRIC AND YOUNGER PATIENTS

被引:168
作者
SINGAL, BM
HEDGES, JR
ROUSSEAU, EW
SANDERS, AB
BERSTEIN, E
MCNAMARA, RM
HOGAN, TM
机构
[1] Wright State University, Dayton, OH
[2] Oregon Health Sciences University, Portland
[3] University of Arizona, Tucson
[4] Boston City Hospital, Boston, MA
[5] Medical College of Pennsylvania, Philadelphia
[6] University of Illinois, Chicago
[7] Society for Academic Emergency Medicine Geriatric Emergency Medicine Task Force, Lansing, MI
关键词
GERIATRICS;
D O I
10.1016/S0196-0644(05)81025-X
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To describe emergency department use by the elderly, to define problems associated with emergency care of the elderly, and to compare these results with those for younger adult patients. Design: Retrospective, controlled chart review. Setting: Six geographically distinct US hospital EDs. Participants: From each site, a stratified sample (approximately 7:3) of elderly (65 years or older) and nonelderly (21 to 64 years old) control patients treated during the same time period was used. Methods: Standardized review of ED records and billing charges. Comparisons of elderly and control patient groups using chi-2 analysis and Mann-Whitney U test (alpha = 0.05). Results: Four hundred eighteen elderly patients and 175 nonelderly controls were entered into the study. The elderly were more likely to arrive by ambulance (35% versus 11%; P < .00001). More elderly than controls presented with conditions of either high or intermediate urgency (78% versus 61%; P < .0003). The elderly more frequently presented with comorbid diseases (94% versus 63%; P < .00001). Other findings for the elderly included a longer mean stay in the ED (185 versus 155 minutes; P < .003), higher laboratory (78% versus 53%; P < .00001) and radiology (77% versus 52%; P < .00001) test rates, higher mean overall care charges ($471 versus $344; P < .00001), and an admission rate 147% versus 19%; P< .00001) twice that of younger adults. Conclusion: Resource use and charges associated with emergency care are higher for the elderly than for younger patients. Increases in emergency resources and personnel or improvement in efficiency will be needed to maintain emergency care at present levels as the US population continues to grow and age.
引用
收藏
页码:802 / 807
页数:6
相关论文
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  • [1] US Senate Special Committee on Aging, Aging America: Trends and Projections, (1988)
  • [2] Linn, Kellermann, Critical decision making Managing the emergency department in an overcrowded hospital, Annals of Emergency Medicine, 20, pp. 287-292, (1991)
  • [3] Andrulis, Kellermann, Hintz, Et al., Emergency departments and crowding in the United States teaching hospital, Ann Emerg Med, 20, pp. 980-986, (1991)
  • [4] Baker, Stevens, Brook, Patients who leave a public hospital emergency department without being seen by a physician, JAMA, 266, pp. 1085-1090, (1991)
  • [5] Bindman, Grumbach, Keane, Et al., Consequences of queuing for care at a public hospital emergency department, JAMA: The Journal of the American Medical Association, 226, pp. 1091-1096, (1991)
  • [6] Hedges, Singal, Rousseau, Et al., Geriatric patient emergency visits Part II: Perceptions of visits by geriatric and younger patients, Ann Emerg Med, 21, pp. 808-813, (1992)
  • [7] Gerson, Skvarch, Emergency medical service utilization by the elderly, Ann Emerg Med, 11, pp. 610-612, (1982)
  • [8] Lowenstein, Crescenzi, Kern, Et al., Care of the elderly in the emergency department, Ann Emerg Med, 15, pp. 528-535, (1986)
  • [9] Baum, Rubenstein, Old people in the emergency department: Age related differences in emergency department use and care, JAm Geriatr Soc, 35, pp. 398-404, (1987)
  • [10] Gillick, Steel, Referral of patients from long-term to acute care facilities, JAm Geriatr Soc, 231, pp. 74-78, (1983)