A 12-year retrospective analysis of differences between elderly and oldest old patients referred to the emergency department of a large tertiary hospital

Objectives: Globally, the average age of the population is increasing. Patients aged > 65 years attending hospital emergency departments (EDs) differ from younger patients; in particular, they often present with multiple comorbidities. Our retrospective study evaluates the number of attendances at our ED by elderly patients in the 12 years from January 2005 to December 2017. Our first aim was to evaluate differences presented by elderly patients regarding symptoms, clinical features, color code (i.e. priority assigned to the case, where red is highest and yellow is medium), waiting time and outcome. Patients and methods: We analyzed data from 201,580 patients aged > 65, divided into two groups: 65-84 years and > 85 years. Clinical and demographic data were collected from the computerized clinical record (GIPSE (R)). Results: 201,580 patients fulfilled the inclusion criteria, of whom 93,262 (46.3%) were male. There were 162,373 patients aged 65-84, and 39,207 aged > 85. Patients aged > 85 presented more complex cases, and were admitted more frequently with a red color code and were more frequently hospitalized. Larger proportions of this group had dementia, and attended the ED for trauma or gastrointestinal bleeding. The group aged 65-84 were admitted more frequently with a yellow color code and then discharged. They typically attended the ED for chest and abdominal pain. Conclusion: There is an increase in the request for health care especially in an emergency setting. The hospitalization of elderly patients is associated with a deterioration in motor skills and quality of life. Being able to reduce hospitalization in the elderly means avoiding disruption to the home care of people with dementia, and reducing both the risk of falls and hospital infections. In Italy, a program (as already experimented with in the USA) dedicated to the elderly who attend hospital EDs is desirable.