Care of the elderly in the emergency department

We prospectively examined the care provided to 234 elderly patients (age greater than or equal to 65) and an equal number of nonelderly patients visiting the emergency department of an urban teaching hospital. Sociodemographic, treatment, cost, and outcome data were collected through ED record reviews and follow-up telephone interviews. The elderly comprised 19% of the ED population and were often nonwhite (31%), Medicaid recipients (39%), living alone (41%), and multiply and chronically impaired. Among old-old patients (age greater than or equal to 75), the most frequent reasons for visiting the ED (19%) were a self-care problem, a fall, or dehydration. Forty-five percent of old-old patients' visits were for true medical emergencies or urgencies. Compared to the nonelderly, the old-old more often were admitted (47% versus 18%, P = .0001), stayed a longer time in the ED (three hours versus 1.9 hours, P = .0001), and incurred a higher charge ($324 versus $208, P = .0001) Twenty-nine percent of these old-old patients who were not initially admitted returned within 14 days (recidivated). The recidivism rate for nonelderly patients was only half as high (15%) (P = .02).