[How to manage very elderly patients in the emergency room? Evaluation of 150 very elderly patients at the Rouen university hospital center].
OBJECTIVE
There are few data in the literature concerning care provided to very elderly subjects referred to emergency care units. The emergency room setting would not be particularly adapted to management of this rising population. The purpose of our work was to assess the frequency of referral to emergency care units, the characteristics of the elderly population, and patient management.


METHODS
One hundred fifty consecutive patients aged over 90 years addressed to the emergency unit of the Charles Nicolle hospital in Rouen France were studied. These patients were cared for by the medical and surgical teams. We recorded, type of referral, hour and reason for admission, degree of handicap and residence, gravity at admission using the clinical classification for emergency care patients (CCMU), complementary tests performed in the emergency unit, duration of stay in the unit and subsequent referral. The characteristics of these "very" elderly patients aged over 90 years were compared with those of "elderly" patients aged 75-90 years.


RESULTS
Over a period of 33 days, the unit cared for 4888 patients, including 150 very elderly patients aged over 90 years (mean age 92.6 years). Daily, 4.4 patients were referred by a primary care physician (76.), mainly between 8 a.m. and 8 p.m. (81.3%). Forty-two percent of the patients had a surgical problem. Two-thirds were unable to walk, one-third had cognitive disorders, and one-third had urinary incontinence. However, half of these very elderly patients lived in a private home. According to the CCMU classification, 14.6% of the patients had a life-threatening disorder. Complementary tests were ordered for most patients (85%). Mean duration of stay in the emergency unit was 3.6 +/- 2.6 days. One quarter of the patients returned to their former residence, with a higher percentage among the surgery patients (37%) than among the medical patients (14.6%). There was no significant difference between the "very elderly" and "elderly" patients in terms of type of referral, duration of stay in the unit and subsequent referral.


CONCLUSIONS
"Very elderly" patients are frequently addressed to emergency care units by their primary care physician. They have severe conditions with major handicaps that largely explain their hospitalization. Our results point out possible improvements for care in the emergency unit.
Moritz
F
F
Réanimation médicale et Service d'Accueil et d'Urgences, Hôpital Charles Nicolle, Rouen. Fabienne.Moritz@chu-rouen.fr
Benez
F
F
Verspyck
V
V
Lemarchand
P
P
Noel
D
D
Moirot
E
E
Chassagne
P
P
Muller
J M
JM
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards*; D005194:Family Practice; D005602:France; D015577:Geriatric Assessment; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data*; D013997:Time Factors; D017749:Total Quality Management; D014218:Triage / Q000379:methods / Q000592:standards