Geriatric patient emergency visits part I: Comparison of visits by geriatric and younger patients

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 χ² analysis and Mann-Whitney Utest (α = 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 (47% 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.