A Geriatric Emergency Service for Acutely Ill Elderly Patients: Pattern of Use and Comparison with a Conventional Emergency Department in Italy

Authors

  • Fabio Salvi MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Valeria Morichi MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Annalisa Grilli MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Raffaella Giorgi MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Liana Spazzafumo MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Stefano Polonara MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Giuseppe De Tommaso MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Alessandro Rappelli MD,

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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  • Paolo Dessì-Fulgheri MD

    1. From the *Department of Internal Medicine, University “Politecnica delle Marche,” Ancona, ItalyGeriatric Emergency ServiceStatistic and Biometry Center, Department of Gerontological Research, Italian National Institute for Research and Care on Aging, Ancona, Italy§Emergency Department, Azienda Ospedali Riuniti, Ancona, Italy.
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Address correspondence to Fabio Salvi, MD, Clinica di Medicina Interna, Azienda Ospedali Riuniti, via Conca n. 71, 60131 Ancona, Italy. E-mail: f.salvi@univpm.it

Abstract

The current disease-oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). In a secondary analysis of a prospective observational cohort of 200 acutely ill elderly patients presenting to two urban EDs in Ancona, Italy, identifiers and triage, clinical, and social data were collected and the following outcomes considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Death, functional decline, any ED revisit and any hospital admission were also considered as a composite outcome. Odds ratios and 95% confidence intervals (CIs) were calculated. Overall, GED patients were older and frailer than CED patients. The two EDs did not differ in terms of early, late, or frequent ED return or in 6-month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22–0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care.

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