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Background: The proportion of people aged over 60 years is growing rapidly worldwide. One consequence for health services is increased presentations by older people to Emergency Departments (EDs). EDs were not designed to manage older people with complex unique needs and multiple co-morbidities. In Australia, many programs have been developed in response to these challenges, but the match between programs and presentation patterns is not clear.
Purpose: To describe 1) the presentation patterns of older people in one metropolitan tertiary level hospital ED and 2) the programs and services connecting with ED for this population.
Methods: Data were extracted from the ED dataset for the year 2010 and patterns of presentations of people aged ≥ 60 years were determined. Consultations were conducted with ED staff and public and private programs providing care in the local context to identify relevant programs.
Results: Of 59,756 presentations, almost a third (32%) were for people aged ≥ 60 years. Repeat presentations (≥ 2) were common in older people, and increased with each decile from 55 years: 55-64 years 21%, 65-74 years 25%, 75-84 years 33%, 85-94 years 36% and ≥ 95 years 34% ( p <.001). In the majority of older people (71%), presentations resulted in hospital admission. Frequent presenters (≥ 4) had highly individual presentation patterns.
Multiple programs were identified to address older peoples’ needs, mostly focusing on subgroups e.g. ≥ 75 years, frequent presenters with chronic illness or specific chronic illness diagnoses. Potential service gaps were evident for patient information, referral and timing of presentation.
Conclusion: Older people form a large proportion of the people seeking care in the ED. While services are available, gaps in support are likely which makes the role of the ED nurse even more complex.