Emergency department (ED) utilization and outcome of oldest old men presenting with geriatric syndromes in a veterans care home in Taiwan

Atypical presentations of older adults at the emergency department and associated factors

“…This study could not identify age, multimorbidity and multiple medications as independent risk factors noted in former reports (Gray-Miceli, 2007;Salvi et al, 2007). The possible explanation for lack of age as a determinant, is that earlier studies compared older adults to younger adults (Amella, 2004;Salvi et al, 2007) but this study focused only on older adults and these results were similar to the study focusing only on older adults (Chou et al, 2009). Though multimorbidity and multiple medications did not show statistical significance, there is abundant evidence regarding the adverse outcomes of polypharmacy and multimorbidity (Ballentine, 2008;Fried et al, 2004;Hayes et al, 2007).…”

“…Most of the patients were referred to the ED for medical reasons rather than for injuries and an infectious condition remains the leading principal diagnoses as in a prior report (Chou et al, 2009). Cardiovascular conditions were not found as much as in other studies (Chou et al, 2009;Samaras et al, 2010) which can be explained because there is a heart center in this area so most cardiac patients are referred to the heart center rather than to Srinagarind Medical School Hospital. Complicated UTI showed a higher proportion of atypical presentations whereas other diagnoses had a greater proportion of typical presentations.…”

“…Urinary incontinence is also a predictor of nosocomial blood stream infections in older adults (Rehman & Qazi, 2013;Samaras et al, 2010). Most of the patients were referred to the ED for medical reasons rather than for injuries and an infectious condition remains the leading principal diagnoses as in a prior report (Chou et al, 2009). Cardiovascular conditions were not found as much as in other studies (Chou et al, 2009;Samaras et al, 2010) which can be explained because there is a heart center in this area so most cardiac patients are referred to the heart center rather than to Srinagarind Medical School Hospital.…”

“…Common classical signs and symptoms include altered mental level, failure to eat and drink e.g., anorexia, failure to develop temperature or fever or lack of pain in a disease known to cause those conditions, functional decline, reduced mobility, falling, fatigue and urinary incontinence (Emmett, 1998;GrayMiceli, 2007;Salvi et al, 2007;Samaras et al, 2010). These symptoms are sometimes known as geriatric syndromes which are prevalent in up to a quarter of older adults at the ED, particularly in institutionalized patients (Chou et al, 2009;Rutschmann et al, 2005). Apart from presenting as geriatric syndromes, variant symptoms of specific diseases often occur such as mild or absent chest pain, dyspnea and no electrocardiogram evidence of acute myocardial infarction, unexplained atrial fibrillation, weakness Table 1 Demographic data and univariate analysis between atypical and typical presentation of older adults at the ED.…”

The Value of Unstructured Electronic Health Record Data in Geriatric Syndrome Case Identification

“…Geriatric syndromes are correlated with high morbidity and mortality and high healthcare use, such as hospitalizations, emergency department (ED) visits, and nursing home admissions . “Geriatric syndromes” is a term used to capture complex and multifactorial clinical conditions in older adults that do not fit into discrete disease categories .…”