Emergency admissions due to reduced general condition

Background In the aged, the symptoms of even serious conditions are often atypical and nonspecific. If the underlying causes of reduced general condition are not recognized when first assessing the patient in emergency care, adequate care may be delayed.

Methods Patients aged 65 and over admitted to a large collaborative emergency department because of reduced general condition in 2017 were included. The incidence and causes of these visits, patient characteristics, and prognosis were analysed using administrative data and patient records. All patients were followed for readmissions and mortality for at least 6 months.

Results The incidence of reduced general condition increased from 17/1000 visits in patients aged 65 to 69 to 189/1000 visits in patients aged 90 and over. The majority of the patients were female and lived at home. Patients with dementia accounted for 23%. One third of the records lacked information about the patient’s living conditions and domestic help needs. Medication data was lacking in 18%. The most common diagnoses were malaise and fatigue (26%), pneumonia (11%) and urinary tract infection (10%). Thirty-day mortality and readmission rates were 7% and 12%, respectively.

Conclusions Reduced general condition is a common reason for ED visits in older people but the underlying cause often remains obscure. The high prevalence of missing information about patients’ backgrounds and medication is worrying.