Utilization of the Accident & Emergency Departments by Chinese elderly in Hong Kong

doi:10.5847/wjem.j.1920-8642.2015.04.006

Abstract

Abstract:

BACKGROUND: The epidemiological data on elderly patients attending Accident and Emergency Departments (AEDs) in Hong Kong is lacking. The study aimed to examine the epidemiology of geriatric patient visits to AEDs in Hong Kong, including demographic data and predictors of life-saving interventions (LSI) and admission.
METHODS: A retrospective cross-sectional study of geriatric patients older than 64 years old attending three AEDs during the year 2012, with a sample of 1 200 patient visits recruited. The data were retrieved from the medical records of the respective hospitals. Descriptive characteristics of the visits were provided. Multivariate logistic regression was performed to evaluate the predictors of LSI and hospital admission.
RESULTS: The mean age of the patients was 79.1 years. Totally 49.7% of the patients were male. "Diseases of the respiratory system" was the commonest diagnosis in AEDs as well as that required admission. The admission rate was 56.8%. Logistic regression demonstrated that dependent activity of daily living (ADL), arrival by ambulance, and the higher number of co-morbidities were predictors of LSI, while advanced age, dependent ADL, institutionalized patients, arrival by ambulance, and higher number of co-morbidities were predictors of hospital admission.
CONCLUSIONS: Ageing population is creating an imminent burden on the emergency service in Hong Kong. Previously unavailable epidemiological information about geriatric attendance to AEDs was described. This forms the basis for development of future studies concerning the medical services on this specific group of patients.

Key words: Elderly, Geriatric, Emergency department, Epidemiology

Wai Lam Yip, Kit Ling Fan, Chun Tat Lui, Ling Pong Leung, Fu Ng, Kwok Leung Tsui. Utilization of the Accident & Emergency Departments by Chinese elderly in Hong Kong[J]. World Journal of Emergency Medicine, 2015, 6(4): 283-288.

Figures/Tables 6

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Figure 1.

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References 15

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Parameters	Patients (%)
Age (median, IQR)	79 (12)
Gender, male	596 (49.7)
ADL
Independent	767 (64.4)
Partially dependent	211 (17.6)
Dependent	213 (17.8)
Unknown	9 (0.8)
Residence
Institution	264 (22)
Home	936 (78)
ED arrival
By self	654 (54.5)
By ambulance	540 (45)
Others	6 (0.5)
Cognitive impairment	257 (21.4)
Triage category
Category 1 Critical	23 (1.9)
Category 2 Emergency	34 (2.8)
Category 3 Urgent	509 (42.4)
Category 4 Semi-urgent	586 (48.8)
Category 5 Non-urgent	44 (3.7)
Unknown	4 (0.3)
Life-saving intervention	238 (19.8)
Airway and breathing	181 (15.1)
Circulatory support	54 (4.5)
Procedures	21 (1.8)
Drugs	56 (4.7)
Disposal
Home	497 (41.4)
Admission	680 (56.7)
Death in ED	7 (0.6)
DAMA	10 (0.8)
Disappeared	4 (0.3)
Mortality	21 (1.8)
Re-attendance in 48 hours	65 (5.4)

Predictors	Adjusted odds ratio (95% confidence interval)	Pvalue
Age	1.02 (0.99-1.05)	0.08
Dependent ADL^*	2.28 (1.58-3.28)	<0.001
Institutionalized	0.79 (0.49-1.27)	0.336
Carried in by ambulance^*	2.17 (1.58-2.99)	<0.001
Cognitive impairment	0.86 (0.51-1.46)	0.581
Number of comorbidities^*	1.16 (1.07-1.24)	<0.001
Diseases of infectious diseases, circulatory orrespiratory system in AED diagnosis^*	4.92 (3.58-6.75)	<0.001

Rank	ICD-10 Code	Description	Frequency	%
1	10	Diseases of the respiratory system	226	18.8
2	11	Diseases of the digestive system	177	14.8
3	19	Injury, poisoning and certain other consequences of external causes	140	11.7
4	13	Diseases of the musculoskeletal system and connective tissue	125	10.4
5	9	Diseases of the circulatory system	122	10.2
6	6	Diseases of the nervous system	103	8.6
7	14	Diseases of the genitourinary system	79	6.6
8	18	Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	64	5.3
9	1	Certain infectious and parasitic diseases	55	4.6
10	12	Diseases of the skin and subcutaneous tissue	31	2.6

Rank	ICD-10 Code	Description	Frequency	%
1	10	Diseases of the respiratory system	163	23.9
2	11	Diseases of the digestive system	122	17.9
3	9	Diseases of the circulatory system	108	15.8
4	6	Diseases of the nervous system	59	8.7
5	14	Diseases of the genitourinary system	52	7.6

Predictors	Adjusted odds ratio (95% confidence interval)	Pvalue
Age^*	1.05 (1.03-1.06)	<0.001
Dependent ADL^*	2.46 (1.50-4.04)	<0.001
Institutionalized^*	2.07 (1.33-3.23)	0.001
Carried in by ambulance^*	1.35 (1.04-1.76)	0.023
Cognitive impairment	1.23 (0.77-1.96)	0.38
Number of comorbidities^*	1.18 (1.11-1.26)	<0.001
Diseases of infectious diseases, circulatory or respiratory system in AED diagnosis^*	2.68 (2.03-3.56)	<0.001