– Between 2011 and 2015, the proportion of elderly patients presenting to the emergency department with psychiatric complaints increased by 20%, according to a retrospective analysis of national hospital data.

In addition, 10-year increases in age, male sex, nursing home status, and Medicare insurance were associated with an increased likelihood of hospital admission.

“The growing geriatric patient population is a well-known phenomenon across every developed country,” lead researcher Derrick Huang said in an interview in advance of the annual meeting of the American College of Emergency Physicians. “A potent mix of increasing life expectancy, greater disease severity and comorbidities in the elderly, and large-scale demographic shifts has placed a significant strain on both our financial and health care resources. This study corroborates these trends in the emergency department and is a preliminary exploration of potential, newly evolving clinical challenges that the ED team will increasingly face into the future.”

For the study, Mr. Huang, a fourth-year medical student at Oakland University William Beaumont School of Medicine in Rochester, Mich., and his colleagues examined National Ambulatory Medical Care Survey (NAMCS) data between 2011 and 2015. They limited the analysis to emergency department visits with patients in the age groups of 65-74, 75-84, and 85 or older. For the primary outcome of interest, the researchers evaluated demographic variables of age group, sex, residential status, race and ethnicity, and insurance for association with hospital admission. For the secondary outcome of interest, they evaluated presenting ED complaints related to the clinical domains of cardiopulmonary disease, psychiatric disease, and fractures and dislocations for potential trends in the ED geriatric age group between 2011 and 2015.

Mr. Huang and his associates found that, as a percentage of total ED visits, those among patients aged 65 or older rose from 14.9% in 2011 to 15.6% in 2015, an increase of 4.7%. By age group, the proportion of visits during the study period was highest for those aged 65-74 years (43.8%), followed by those aged 75-84 years (34.7%) and those aged 85 and older (21.5%). On multivariate analysis, the 75-84 and age-85-and-older groups were 1.30 and 1.71 times more likely to be admitted to the hospital, compared with the 65-74 group, respectively (P less than .000 for both).

Men were 1.19 times more likely than were women to be admitted (P less than .000). In addition, elderly patients who reside in nursing homes were 1.70 times more likely to be admitted to the hospital, compared with those who lived in private homes (P less than .000), while those with Medicare insurance were 1.57 more likely to be admitted, compared with those who did not have insurance (P = .004).

On trend analysis, ED psychiatric complaints rose incrementally during the study period, from 3.9% in 2011 to 4.7% in 2015, a relative increase of 20.5%. The researchers identified no consistent trend with visit complaints related to cardiopulmonary disease, and fractures and dislocations.

“This was not too surprising, because these difficulties with older patients are not new and many investigators have sought out solutions,” Mr. Huang said. “For example, there have been many interventions both in the ED as well as in the primary care setting designed to identify risk factors and facilitate postdischarge care to prevent falls. These approaches are constantly evolving and will be of increasing importance.”

With large-scale demographic shifts and increasing life expectancy, he continued, elderly patients are likely to evolve further in complexity.

“For example, we may be seeing a larger of proportion of patients with acute mental health complaints,” Mr. Huang said. “We will need to continue developing our multidisciplinary approach to care by improving coordination with different specialties – and especially outpatient and community health care providers.”

The study’s senior author was Jason Wasserman, PhD of Oakland University William Beaumont School of Medicine. The researchers reported having no financial disclosures.

SOURCE: Huang D et al. Ann Emerg Med. 2018 Oct. doi: 10.1016/j.annemergmed.2018.08.212.