Introduction
Within Emergency Medicine, older adults represent a distinct population with unique needs and challenges. There is a scarcity of epidemiologic data on the requirements of Ireland’s older population for, and their utilisation of, emergency care networks. We sought to assess this deficit utilising data from the recently published European Geriatric Emergency Departments Registry Study (EGERS) dataset.
Methodology
A prospective, cohort study of older adult patients (≥65) presenting to Irish Emergency Departments over a 7-day period. The dataset was originally collected as part of the EGERS study. The Irish subpopulation was extracted, analysed in further detail, and compared to the remaining non-Irish population. Data on demographics, presenting complaint, vital signs, chronic medication and co-morbidities were compared. Outcome data including emergency department and hospital length of stay, ICU admission and mortality rate were also assessed.
Results
A total of 361 Irish patients were identified. Median (IQR) age was 77(71-82) and 193(53.5%) were male. The proportion of patients aged >85 was higher in the non-Irish population (24.0% vs 13.9%, RR 1.13, 95% CI 1.08-1.18).
The most common presenting complaints were falls (N=65, 18%), shortness of breath (N=51, 13.5%), chest pain (N=44, 11.7%) and abdominal pain (N=37, 9.8%). Multiple presenting complaints occurred in 69(19.1%) patients. Traumatic presenting complaints occurred in 67(18.6%) with 9(2.5%) patients reporting mixed traumatic and non-traumatic presentations.
The median (IQR) number of co-morbidities in the Irish population was 3 (2-5). Co-morbidities were more common in the Irish population (96.1% vs 89.5%, RR 1.07 95% CI 1.05-1.10), with dyslipidaemia, coronary artery disease, heart failure and asthma/COPD being significantly more frequent. Median (IQR) number of regular medications was 4 (2-6) and chronic medication usage was higher in the Irish population (92% vs 84%, RR 1.10, 95% CI 1.06-1.14). Disability and need for support services was high with 96 (27.8%) patients utilising home help services, while 85 (24.6%) reported previous falls.
Admission rates were high (N=186, 52.0%), with no differences between populations. There was no mortality difference between the groups. Irish patients were less likely to be admitted to ICU (2.2% vs 8.7%, RR 0.94, 95% CI 0.92-0.97).
Conclusion
Irish older adults attending emergency departments present in complex manner and demonstrated higher comorbidity than their European counterparts.