Older Patients in the Acute Setting - Is There a Better Solution?

Anette Addy Ekmann, Hanne Nygaard, Miriam Reichstein Wejse, Ann Kathrin Demény, Eckart Pressel

Abstract

Background Older patients (>65 years) admitted to the Acute Medical Unit (AMU) at Bispebjerg Hospital count for 53 % of all bed-days. Due to demographical changes this number is expected to rise during the coming years. These patients are often characterized by complex health related and medication problems, functional loss and atypical presentation of symptoms. The aim of this study was and to investigate if older patients could benefit of acute geriatric assessment by our new established Geriatric Acute Team (GATE). Methods All patients > 65 years admitted to the AMU were screened every morning between March and June 2016. Exclusion criteria were medical unstable conditions and need for specialized medical treatment. Patients enrolled in March-April and May-June accounted for the control and case group, respectively. The control group received treatment after usual standard at the AMU, whereas, the case group received an acute geriatric assessment conducted by a senior consultant in geriatric medicine. Data were retrieved from the patient’s medical journals and included demographic and medical related variables. Results We included 183 patients as controls and 150 as cases. Seventy-two (72) and 96 of control and case patients, respectively accepted participation in the study. On average 3.7 patients was enrolled in our GATE daily. At enrollment, average age was 81 years (65-101), 71 % had polypharmacy (>5 pharmaceuticals) and 58 % had more than 3 simultaneous present diseases. Implementing GATE gives shorter hospitalization times at AMU (p=0.03), fewer doctors attending the single patient (p=0.02) and lower 30-day readmission in the case group (p=0.05). Overall, transfer to a specialized ward is the same in cases and controls. However, among transferred patients, more case patients were transferred to the geriatric ward (p=0.002). Furthermore, results indicated more use of interdisciplinary (p= 0.07) and intersectoral (p=0.06) services in the case group. Conclusion Elderly frail patients acutely admitted, but not in need of specialized medical treatment, benefit from early geriatric assessment at the AMU. They experience shorter admission times, more coherent clinical pathway, and reduced number of readmissions.
Original languageEnglish
Publication date2016
Number of pages1
Publication statusPublished - 2016
EventDANISH EMERGENCY MEDICINE CONFERENCE 2017 - Scandic, København, Denmark
Duration: 24 Nov 2016 → …

Conference

ConferenceDANISH EMERGENCY MEDICINE CONFERENCE 2017
LocationScandic
Country/TerritoryDenmark
CityKøbenhavn
Period24/11/2016 → …

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