Acute medical take or subacute-on-chronic medical take?

Older people are a significant source of emergency admissions to general hospitals relative to their proportion of the population. Little is known of the acuity of these admissions, aspects of which this study aims to determine.

A prospective survey of 1 in 10 acute general takes in a university teaching hospital over 11 months. Age, sex, acuity of presentation, premorbid functional status and cognitive impairment were recorded.

Of 332 admissions, 127 (38%) patients were aged 65 years or over and 205 under 65. Of > or =65's, 53 (42 ) presented <2 days of symptoms compared to 117 (57%) <65's. Mean delay between onset of primary symptom and presentation was 8.76 days (> or =65's) and 6.77 days (<65's). Previous functional loss was present in 42% of > or =65's. On admission, 36% of > or =65's were deemed cognitively impaired.

Acute on chronic illness represents a significant proportion of 'acute general take'. Older patients admitted in this fashion also tend to present to hospital later after the onset of their symptoms and with more physical and cognitive impairment than younger counterparts. These findings are supportive of the development of better models for managing chronic disease, such as acute geriatric medicine, stroke units, admission avoidance strategies and focussed community supports.