The oldest old in the Emergency Department: Impact of renal function

• Published in: The Journal of nutrition, health & aging health & aging, 2016-12, Vol.20 (10), p.1045-1050
• Main Authors: Brünnler, Tanja, Drey, M., Dirrigl, G., Weingart, C., Rockmann, F., Sieber, C., Hoffmann, U.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aging; Blood Pressure; Departments; Emergency medical care; Emergency Service, Hospital; Female; Follow-Up Studies; Geriatrics; Geriatrics/Gerontology; Glomerular Filtration Rate; Health care expenditures; Heart Rate; Hospitals, Teaching; Humans; Internal medicine; Kidney - physiopathology; Kidney diseases; Length of Stay; Male; Medicine; Medicine & Public Health; Mortality; Multivariate Analysis; Neurosciences; Nutrition; Older people; Oxygen saturation; Patients; Population; Primary Care Medicine; Quality of Life Research; Teaching hospitals
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-016-0731-0

Objectives The ageing population implicates an increasing numbers of older adults attending Emergency Departments (ED). We assessed the effect of estimated glomerular filtration rate as a predictor of clinical outcomes in oldest-old patients ≥ 85 years attending the ED in an university teaching hospital. Design Within three years, 81831 patient contacts were made in our ED. 7799 (9.5%) were older than 85 years, in whom we analyzed the impact of renal function on various outcome parameters. Furthermore, this patient group was compared to the patients > 85 years. Results Within the group of patients ≥ 85 years, not older age, but as denominator decreased glomerular filtration rate led to significant longer hospital stays. In addition, impaired kidney function was associated with lower heart rates, lower blood pressure, lower oxygenation, a higher rate of established ambulant care setting, as well as higher mortality. Compared to younger patients, the oldest-old significantly differed with regard to medical attribution (e.g. internal medicine, surgery), sex distribution, length of hospital stay, Manchester triage score, Glasgow Coma Scale, visual analogue pain scale, heart rate, blood pressure, oxygen saturation as well as fall prophylaxis, outpatient care, and presence of relatives. Conclusion In conclusion, in this large collective of oldest-old patients, impaired kidney function seems to be a more important determinant in adverse outcome and thus increased health care costs than age per se. Adapted strategies in EDs to adjust diagnostic and treatment strategies for this population are thus warranted.