A two-year follow-up of geriatric consults in the emergency department

OBJECTIVE: To characterize the population and provide a 2-year follow-up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital. BACKGROUND: Older people tend to use health services, including the ED, disproportionately. This phenomenon has implications for medical services as the number of older people continues to increase. To our knowledge, long-term follow-up of patients for whom ED geriatric consultation was requested has not been described. SETTING: The emergency department of a 628-bed tertiary care university hospital in Montreal, Canada. SUBJECTS: 326 older patients examined in the ED by a geriatric consult team (GCT). METHODS: The records kept by the GCT during a 12-month period were reviewed retrospectively, and the patient cohort was followed for 2 years by telephone or review of hospital charts. Mortality, rate of revisit to ED, readmission to hospital, and final disposition were examined. RESULTS: The study revealed a particularly high hospital admission rate (63.5%) among those older people consulted by the GCT. The high pre valence rates for the classic geriatric syndromes of falls, incontinence, iatrogenic events, and confusional states suggest a need to address these problems early in their presentation, preferably beginning in the ED. A 2-year follow-up exhibited high mortality rates (33.7%) as well as a long-term institutionalization rate of 52%. CONCLUSION: The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high-risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow-up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow-up after hospital discharge.