A two-year follow-up of geriatric consults in the emergency department.
OBJECTIVE
To characterize the population and provide a 2-year follow-up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital.


BACKGROUND
Older people tend to use health services, including the ED, disproportionately. This phenomenon has implications for medical services as the number of older people continues to increase. To our knowledge, long-term follow-up of patients for whom ED geriatric consultation was requested has not been described.


METHODS
The emergency department of a 628-bed tertiary care university hospital in Montreal, Canada.


METHODS
326 older patients examined in the ED by a geriatric consult team (GCT).


METHODS
The records kept by the GCT during a 12-month period were reviewed retrospectively, and the patient cohort was followed for 2 years by telephone or review of hospital charts. Mortality, rate of revisit to ED, readmission to hospital, and final disposition were examined.


RESULTS
The study revealed a particularly high hospital admission rate (63.5%) among those older people consulted by the GCT. The high prevalence rates for the classic geriatric syndromes of falls, incontinence, iatrogenic events, and confusional states suggest a need to address these problems early in their presentation, preferably beginning in the ED. A 2-year follow-up exhibited high mortality rates (33.7%) as well as a long-term institutionalization rate of 52%.


CONCLUSIONS
The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high-risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow-up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow-up after hospital discharge.
Sinoff
G
G
Department of Geriatrics, Carmel Medical Center, Haifa, Israel.
Clarfield
A M
AM
Bergman
H
H
Beaudet
M
M
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015996:Survival Rate