Short Takes On News & Events

Study: Emergency Rooms Take Toll On Older Patients

By Kelsey Miller

July 1st, 2013, 3:13 PM

The majority of older patients who go to emergency departments in several nations around the world are likely to start out with complex conditions that deteriorate after their visits, according to a study published in the June 25 issue of Annals of Emergency Medicine.

Researchers from the Centre for Research in Geriatric Medicine at the University of Queensland, Australia, studied patients 75 years or older in emergency departments around the world to paint a picture of the unique problems they face — and how ERs can change to better serve them.

Lead author Dr. Leonard C. Gray said older people who arrive at emergency departments are more likely to have “geriatric syndromes” such as immobility, confusion and incontinence. The findings also indicated that for many, functional and cognitive issues increased afterward.

“These problems increase the complexity of care, and require specific interventions to ensure the best results,” Gray said in an email.

Researchers studied 2,282 patients in 13 different emergency departments in seven countries including Australia, Belgium, Canada, Germany, Iceland, India and Sweden. They looked at medical records, talked to hospital staff and interviewed the patients directly about their cognitive function, mood, comprehension and more. Researchers also tracked the patients’ progress for 28 days after their ER visit.

Before coming to the ER, 54 percent were independent and didn’t require help for daily activities. After, only 33 percent were still listed as “completely independent.”

The number of patients studied who displayed symptoms of cognitive impairment rose 6 percent after their trips to the ER, and the number of those who could not walk without assistance rose 23 percent.

Though the study fails to look into specific reasons why these older patients were negatively affected by ER visits, researchers say the numbers should be a signal for hospitals. “With population aging, and relative reductions in severe health problems among younger age groups, the proportion of patients in the [emergency department] who are older is likely to increase,” Gray said. “Therefore, the case for designing the [emergency department] to cater for the needs of older people will escalate continuously.”

Such steps could include simple changes in furniture or lighting or more complex changes such as staff training and risk minimization.

“It seems not a matter of ‘if,’ but rather ‘when’ adjustments should be made,” Gray said.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

4 Responses to “Study: Emergency Rooms Take Toll On Older Patients”

  1. Brian J. Glenn says:

    We have to be careful so as not to mistake correlation with causation. If someone’s body has a triggering event, such as a stroke, they will not be in the same physical condition after the event as before. So if they have a stroke, and go to the ER, they will show a decline, but that was not due to going to the ER, but rather to the event.

    Indeed, many conditions would be much worse (if not fatal), without a visit to the emergency room.

    BJG

  2. Emergency rooms need to have better tools and methods to communicate with us older Americans. It is rare that a true joint establishment of meaning is established by the initial conversations that take place, and it is rarer still that ER’s record the special communication needs of patients in a way that follows along with those who are hospitalized. Yet, as the Joint Commission has reported, communication breakdowns contribute to more than 60% of negative events in hospitals, and in many cases those negative events contribute to the downhill slide of patient functioning.

  3. Steve Soumerai says:

    Brian is absolutely right. This is a totally select population with a medical illness precipitating ER admission. This is the kind of biased study that would not be counted as evidence in a professional systematic review like those conducted by the Cochrane Foundation. The interpretations in the news article are unfounded and the story itself gives a wrong impression. If I had a heart attack and went to the ER and was not saved, did the ER kill me?
    Silly. 75% of all published articles are biased and we–the public, news reporters, editors, researchers, and funders–need to be much more critical of what we read, especially poorly designed studies.

  4. ELLEN TAYLOR, MD says:

    We as a society need to come to grips with the natural history of disease, and, when patients are facing the end of life, acknowledge it with palliative medicine, not the ICU. Until we can do that, older patients who should probably be in Hospice, not the hospital, will continue to look “bad’ in term os raw numbers of who did well, who did poorly.

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