Atypical presentations of older adults at the emergency department and associated factors.
OBJECTIVE
The objectives were to determine the prevalence of atypical presentations among older adults at the Emergency Department (ED) of a tertiary care hospital and to identify factors associated with these presentations.


METHODS
A retrospective medical record audit was randomly reviewed in 633 patients who were aged ≥ 65 years who attended the ED of Srinagarind Medical School Hospital in 2013. Demographic data were collected and were analyzed using descriptive statistics. Regression analysis was used to analyze the variables associated with the outcomes.


RESULTS
The prevalence of an atypical presentation was 28.6% (181/633 cases). The failure to develop fever with a disease known to cause fever was the most common atypical presentation of illness (34.42%). Independent factors associated with atypical presentations were complicated urinary tract infection (UTI) (odds ratios (OR) 4.66, 95% confidence interval (CI) 2.0, 10.84, p=0.00) and a background of dementia (OR 3.48, 95% CI 1.38, 8.77, p=0.008).


CONCLUSIONS
The prevalence of atypical presentations of older adults at the ED was about a third. The absence of fever with a disease known to cause fever was the most common atypical presentation. Complicated UTI and demented patients were the independent risk factors associated with the atypical presentations. Early awareness of non-specific presentations and applying comprehensive geriatric assessments among older patients at the ED is recommended.
Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Electronic address: lpanit@kku.ac.th.
Panita
P
Limpawattana
Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Pariwat
P
Phungoen
Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Thapanawong
T
Mitsungnern
Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Wannisa
W
Laosuangkoon
Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Natthida
N
Tansangworn
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*
Emergency service; Frail elderly; Geriatric syndrome