to them will be of special concern. The aims of this study were to: (1) identify key social problems among the elderly as they present to an emergency department; (2) compare the epidemiology, assessment and treatment patterns with results from a similar study performed at this institution in 1989. Methods: This was a retrospective, cohort analysis of consecutive patients more than 64 years old who received medical social work (MSW) consultation in the emergency department (ED) at a university-affiliated hospital during a two-year study period (2013-2014). Demographics, medical history, presenting complaints, treatment, and disposition were obtained from ED records. Standardized abstraction forms were used to guide data collection. One investigator performed a blind critical review of a random sample of 10% of the charts to determine reliability. The main outcome criterion was the frequency of key social problems among the elderly. Epidemiology, assessment and treatment patterns were then compared to results from a similar study performed 25 years ago. Discrete variables were analyzed with the use of Yates chi-square test, corrected for continuity; 2-tailed unpaired t-tests and Wilcoxon rank sum tests for continuous and ordinal data. Results: During the study period, 1309 consecutive elderly patients received MSW consultation in the ED. The mean age was 78.4 AE 9.1 years; the oldest patient was 100 years old. The majority of elderly lived at home alone (31.4%) or with a family member or caregiver (47.6%). Twenty risk factors were identified that predisposed older patients to psychosocial emergencies, including polypharmacy (47.5%), hospitalization with past 6 months (30.7%), social isolation (28.3%), functional disability (20.6%), and memory impairment (18.8%). A total of 18 psychosocial problems were identified; elderly spent approximately 10.0 AE 12.1 hours in the ED. Compared to a similar study at our institution in 1990, the number of MSW consults in elderly patients has increased almost threefold (370%). There are more male patients (49% vs 39%, P < .001), and each patient has a greater number of risk factors (3.5 vs 2.3, P < .001) and individual psychosocial problems (3.0 vs 1.9, P < .001). The spectrum of psychosocial disease has also changed with significantly more terminal illness, caretaking issues, medication assistance, social isolation, and self-neglect. Despite a net increase in the number of community resources utilized, more patients experienced a change in their living situation after discharge from the ED (43.9% vs 24.9%, P < .001). Significant changes included greater use of short-term hospitalization, subacute rehabilitation centers, hospice care, and psychiatric admissions. Conclusions: During the past 24 years at our institution, the number and spectrum of psychosocial emergencies in older patients has significantly changed. There are greater numbers of "high-risk" elderly with caregiver exhaustion, financial constraints, functional decline, depression, self-neglect, and social isolation. Al...
