CLINICAL CHARACTERISTICS AND OUTCOMES OF ELDERLY PATIENTS (≥60 YEARS) ADMITTED THROUGH EMERGENCY MEDICAL SERVICES: A RETROSPECTIVE STUDY
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Keywords
: elderly patients, emergency medical services, geriatric emergency, in-hospital mortality, APACHE II, comorbidities, Rajasthan, tertiary care
Abstract
Background: Elderly patients (≥60 years) constitute a rapidly growing proportion of emergency department (ED) admissions globally and in India, presenting with complex comorbidities, atypical clinical features, and higher rates of adverse outcomes compared to younger adults. Despite the increasing burden, data on the clinical profile, presenting complaints, and in-hospital outcomes of geriatric emergency admissions from tertiary care centres in Rajasthan remain scarce.
Objectives: To describe the clinical characteristics, spectrum of presenting complaints, comorbidity burden, and in-hospital outcomes of elderly patients (≥60 years) admitted through emergency medical services (EMS) at Pacific Institute of Medical Sciences (PIMS), Udaipur, Rajasthan, during January 2024 to December 2024, and to identify independent predictors of in-hospital mortality in this cohort.
Methodology: A retrospective observational study of 300 elderly patients (≥60 years) admitted through EMS at PIMS, Udaipur, from January to December 2024 was conducted. Inpatient records were reviewed for demographics, presenting complaints, vital signs, comorbidities, laboratory parameters, APACHE II score at admission, duration of hospital stay, ICU admission, and in-hospital mortality. Multivariate binary logistic regression using SPSS v25 identified independent predictors of in-hospital mortality.
Results:Of 300 elderly EMS admissions (mean age 69.4 ± 7.8 years, 58.7% male), in-hospital mortality occurred in 48 (16.0%). The most common presenting complaints were dyspnoea (29.7%), chest pain (22.3%), altered sensorium (18.0%), fall/syncope (12.0%), and fever (10.3%). Predominant aetiologies were cardiovascular disease (38.3%), respiratory conditions (21.7%), and acute neurological events (16.0%). On multivariate logistic regression, APACHE II score ≥20 (OR 6.42, 95% CI 2.81–14.67, p<0.001), serum creatinine >2.0 mg/dL (OR 4.11, 95% CI 1.74–9.71, p=0.001), need for mechanical ventilation (OR 5.87, 95% CI 2.33–14.80, p<0.001), altered sensorium at presentation (OR 3.74, 95% CI 1.58–8.84, p=0.003), and number of comorbidities ≥3 (OR 3.21, 95% CI 1.35–7.63, p=0.008) were independent predictors of in-hospital mortality.
Conclusion:Elderly patients admitted through EMS at this southern Rajasthan tertiary care centre carry a substantial mortality burden of 16.0%, driven primarily by cardiovascular and respiratory emergencies. APACHE II score, renal dysfunction, need for mechanical ventilation, altered sensorium, and multiple comorbidities are independent predictors of in-hospital mortality. Early risk stratification using these parameters can guide clinical prioritisation and resource allocation in the geriatric emergency setting.
References
[2] Jokanović N, Tan ECK, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Clin Pharm Ther. 2015;40(3):256–263.
[3] Sinha A, Mukherjee S, Tripathi S, Dutta S. Issues and challenges of polypharmacy in the elderly: A review of contemporary Indian literature. J Family Med Prim Care. 2021;10(10):3544–3547.
[4] Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39(3):238–247.
[5] Hwang U, Shah MN, Han JH, Carpenter CR, Siu AL, Adams JG. Transforming emergency care for older adults. Health Aff (Millwood). 2013;32(12):2116–2121.
[6] Choi W, Woo SH, Kim DH, Lee JY, Lee WJ, Jeong S, et al. Prolonged length of stay in the emergency department and mortality in critically ill elderly patients with infections: A retrospective multicenter study. Biomed Res Int. 2021;2021:9952324.
[7] Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: A review. Ann Emerg Med. 2010;56(3):261–269.
[8] GBD 2019 India Collaborators. India state-level disease burden initiative cardiovascular disease collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob Health. 2020;8(10):e1316–e1326.
[9] Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation. 2016;133(16):1605–1620
[10] Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R, et al. Frailty and multimorbidity: A systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2019;74(5):659–666.
[11] Upparakadiyala R, Singapati S, Sarkar MK, Swathi U. Clinical profile and factors affecting outcomes in elderly patients admitted to the medical intensive care unit of a tertiary care hospital. Cureus. 2022;14(2):e22136.
[12] Grossmann FF, Zumbrunn T, Frauchiger A, Delport K, Bingisser R, Nickel CH. At risk of undertriage? Testing the performance and accuracy of the emergency severity index in older emergency department patients. Ann Emerg Med. 2012;60(3):317–325.
[13] Bloom DE, Chatterji S, Kowal P, Lloyd-Sherlock P, McKee M, Rechel B, et al. Macroeconomic implications of population ageing and selected policy responses. Lancet. 2015;385(9968):649–657.
[14] Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011;10(4):430–439.
[15] Mittal K, Dhar M, Pathania M, Saxena V. Clinical characteristics and outcomes in elderly patients with COVID-19: A single-centre retrospective study. Cureus. 2022;14(5):e25506.
[16] Tahir S, Ganie BA, Beigh TY, Hazar AJ, Reshi AR. Clinico-etiological spectrum and outcome in patients with septic acute kidney injury and its comparison with non-septic acute kidney injury: A hospital-based prospective study. Cureus. 2023;15(4):e37857.
[17] Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, Hogan TM. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: A systematic review and meta-analysis. Acad Emerg Med. 2015;22(1):1–21.
[18] Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32(12):911–915.
[19] Ustaalioğlu I, Ak R, Cimilli Öztürk T, Koçak M, Onur Ö. Investigation of the usability of the REMS, RAPS, and MPM II0 scoring systems in the prediction of short-term and long-term mortality in patients presenting to the emergency department triage. Ir J Med Sci. 2023;192(2):907–913.
[20] Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–687.
[21] Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–1066.
[22] Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;(7):CD006211.
[23] Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements AC. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in South and Southeast Asia: a systematic review. BMC Infect Dis. 2019;19(1):1–7.
[24] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818–829.
[25] Gasem MH, Kosasih H, Tjitra E, Alisjahbana B, Karyana M, Lokida D, et al. An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia. PLoS Negl Trop Dis. 2020;14(1).
[26] James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858.
[27] Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–1423.
[28] Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology’s 0by25 initiative for acute kidney disease (zero preventable deaths by 2025): A human rights case for nephrology. Lancet. 2015;385(9987):2616–2643.
[29] Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–495.
[30] Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of mortality in elderly and very elderly emergency patients with sepsis: A retrospective study. West J Emerg Med. 2020;21(6):1486–1494.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Dr. Upadhyay Aakash Alkeshkumar
Assistant Professor, Department of General Medicine, Pacific Institute of Medical Sciences, Girwa, Udaipur, Rajasthan, India
Dr. Alok Pritam
Assistant Professor (Statistics), Department of Community Medicine, Late Shree Lakhiram Agrawal Memorial Medical College, Raigarh, Chhattisgarh, India
