Infections Drive Emergency Department Visits by the Elderly

Pam Harrison

January 11, 2016

More elderly patients visited emergency departments in the United States for infectious disease–related diagnoses in 2012 than for myocardial infarction and congestive heart failure combined, a nationally representative sample of the elderly has found.

The study was published online December 23, 2015, in the Journal of the American Geriatrics Society.

"These findings reinforce the fact that [infectious diseases] continue to be an important problem in elderly adults — the fastest-growing population in the U.S. population — in an already stressed healthcare system," Tadahiro Goto, MD, from the University of Fukui Hospital in Japan, and colleagues write.

The study authors used data from 2012 from the Nationwide Emergency Department Sample (NEDS), a nationally representative emergency department visit database, to calculate rates of infectious disease–related visits to emergency departments across the United States, as well as hospitalization and mortality rates from infectious disease–related diagnoses. All visits to emergency departments by adults 65 years of age and older who had received an International Classification of Diseases, Ninth Revision, Clinical Modification, code for an infectious disease were included in the analysis.

Using these data, Dr Goto and colleagues estimate that elderly patients in the United States made 3.1 million visits to emergency departments for an infectious disease–related condition. These visits accounted for 13.5% of all visits by the elderly to emergency departments over the course of the year.

The most common infection driving elderly visits to emergency rooms was a lower respiratory tract infection, which accounted for 26.2% of all visits. This was followed by urinary tract infections, which accounted for 25.3% of all visits, and septicemia, which accounted for 18.9% of emergency department visits, the authors report.

Pneumonia accounted for 17.5% of the visits, they add, whereas influenza accounted for only 1.1% of all visits.

Of the 3.1 million infectious disease–related emergency department visits, 57.1% resulted in hospitalization. The most frequent reason for elderly patients with an infection to be hospitalized was septicemia, which was responsible for almost one third of all infectious disease–related hospitalizations. Lower respiratory tract infections followed, at 27.8% of all hospitalizations. Urinary tract infections also triggered a high proportion of visits to emergency departments, but the elderly were less likely to be hospitalized for them, as these infections led to only 17.2% of all hospitalizations for infections among the elderly.

The proportion of the elderly who were admitted to hospital with an infectious disease diagnosis was also higher than it was for elderly patients visiting the emergency department for a non–infectious disease diagnosis (18.5% vs 13.4%; P < .001).

Similarly, more of the elderly patients admitted to hospital for an infectious disease diagnosis died in hospital, at 0.82%, compared with those who died in hospital from a non–infectious disease cause, at 0.44% (P < .001).

The researchers note that the proportion of emergency department visits for infectious diseases increased from 12.3% for patients between 65 and 74 years of age to 13.7% for those between 75 and 84 years of age, and to 15.5% for adults 85 years of age and older.

The highest hospitalization rate for an infectious disease diagnosis was also seen in patients aged 85 years and older, accounting for 66.5% for all hospitalizations among the elderly.

The authors suggest that with wider uptake of currently available vaccines, both visits to the emergency department by the elderly and the subsequent need for hospitalization might be at least attenuated.

One coauthor receives tuition support jointly from Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). Another coauthor is funded by Honjo International Scholarship Foundation. The other authors have disclosed no relevant financial relationships.

J Am Geriat Soc. Published online December 23, 2015. Full text


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