The research denies the cliché according to which the elderly are the main cause of unnecessary visits to the emergency room. A new Italian study, conducted by experts from the Italian Society of Geriatrics in the local hospital (Sigot) and the Italian Society of Gerontology and Geriatrics (Sigg), unique in the size of the sample examined – underlines a note – indicates that the visits of the elderly to the emergency room “are appropriate 4 times more than in young people, going from 10.7% in the 40-44 age group to 36.8% and 44.2% in the more advanced age groups. An increase in appropriateness that is also found in hospitalizations, more justified in the elderly”.
The work was published in ‘Geriatrics & Gerontology International’, is based on Emur (Emergency and Urgency Information System) data from the Ministry of Health and examines the 20,400,071 accesses to the emergency room in 2015, corresponding to 335 admissions per thousand inhabitants. “The reference year is exemplary and the data remain current, also by virtue of the high number of patients considered and the extension to the whole national territory”, specify the authors who propose to “increase hospital beds for the elderly, strengthen hospitals. And then” to foresee “the presence of a geriatrician consultant in the emergency room”.
The study analyzes the accesses based on age and verifies their appropriateness with the criterion of the different severity codes: the severity is low with a white or green code, while the yellow code indicates an emergency situation and the red one the imminent life threatening. “The appropriateness (validated yellow or red code) of visits to the emergency room – the specialists point out – progressively increases with age: it is 6.3% in the 5-9 year age group, 10.7% in the 40-44 years, by 36.8% in the 85-89 age group and reaches up to 44.2% in the 95-99 age group”. After the emergency room visit, the patient can be discharged or, in severe cases, hospitalized. Well, the study also shows that “the appropriateness of subsequent hospitalization grows with age, i.e. the percentage of subjects who are hospitalized only in the presence of really serious pathologies, marked in the emergency department by a yellow or red code, rises. The study also shows that inappropriate hospitalizations, following the assignment of a white or green code, are much more frequent among young adults than among the elderly”.
The research shows that the phenomenon of overcrowding in emergency rooms is closely linked to the aging of the population. “Accesses grow progressively with age: out of a thousand inhabitants over the age of 90 there are 500 accesses a year, while they drop to around 200-250 in the lower age groups – underlines Filippo Luca Fimognari, co-author of the study and director of Geriatrics and the Medical Department of the Cosenza hospital – Furthermore, the study denies the widespread perception according to which inappropriate accesses to the emergency room are above all by elderly people: only in 10% of cases are there appropriate hospitalizations among young adults, 4 times less than the elderly”.
“This article photographs what happens in the emergency room. It is the first time that such an analysis has been carried out in Italy, with such a large number – remarked Lorenzo Palleschi, president-elect of Sigot, director of Geriatrics and the Internal Medicine Department of the S. Giovanni-Addolorata Hospital of Rome, and Andrea Ungar, president of Sigg and full professor of Geriatrics, University of Florence – The survey shows that a strengthening of territorial assistance, a fundamental objective for the National Health Service, cannot be the only tool to solve the problem of overcrowding in the emergency room. This phenomenon, on the other hand, is linked to the aging of the population which is often not healthy aging, rather it is accompanied by various concomitant comorbidities”.
According to Palleschi and Ungar “it is therefore necessary to equip ourselves with multiple synergistic actions: first of all, it is necessary to strengthen hospitals by increasing the number of beds dedicated to this vulnerable segment of the population, increasing the number of complex Geriatrics operating units and reversing a trend which, paradoxically, in recent years has seen a reduction in these beds just as the number of elderly people was growing.Furthermore, given the growth in the average age of the hospital population, the offer of geriatric services within hospitals should be increased: Orthogeriatrics, ‘delirium room’, Oncogeriatrics Finally, provision should be made for the geriatric consultant to be included in the emergency room, regardless of the possible presence of a complex geriatrics operating unit in the relative hospital”.