Healthcare News & Insights

4 warning signs to watch for in elderly ED patients

Hospitals need to take into account the specific needs of elderly patients when they’re admitted – particularly since Medicare’s coming after hospitals for poor outcomes such as readmissions. New research shows there are several red flags that an elderly person’s condition may decline to the point where he or she will need more care. 

ThinkstockPhotos-100041130A study published in the Annals of Emergency Medicine focused on the health of older patients who visited the emergency department (ED). Researchers examined the records for hundreds of ED visits among adults over age 65 at Kaiser Permanente Southern California.

They looked for commonalities in patients who experienced poor outcomes – specifically, death or admission to the intensive care unit within seven days of discharge from the ED.

Signs of pending trouble

Per researchers’ findings, elderly patients in the ED who have any of these four characteristics are at higher risk of dying or being admitted to the ICU up to seven days after they leave the hospital:

  1. Cognitive impairment. Older adults who experienced an acute change in mental status or chronic cognitive impairment were more likely to be either admitted to the ICU or die seven days after ED discharge. Researchers theorized that these patients may have a tougher time understanding discharge instructions or the details about new medications. Another theory: A shift in mental status is a signal of other pending physical changes. Few ED providers are trained in how to properly interact with older patients – or how to recognize signs of mental decline. So these issues often go unnoticed until it’s too late.
  2. A change in disposition plan from admit to discharge. Disposition refers to the type of care and treatments patients will be receiving after being discharged from the ED. If there are any differences from admit to discharge, such as new medications or a new setting for care, older patients are more likely to have poor outcomes. Elderly patients who leave the ED against medical advice also experience these issues. The use of specialty consultants in the ED, who assist patients with accessing care, follow-ups and services outside of the provider’s scope of practice, helped elderly people better weather changes in their disposition plan.
  3. Low blood pressure. Older patients with a systolic blood pressure that’s less than 120 mm Hg were more likely to experience death or an ICU admission after being in the ED, which is consistent with other studies suggesting that low blood pressure is dangerous. This means that ED providers may want to give extra attention to older patients with low blood pressure before discharging them.
  4. Elevated heart rate. Another vital sign issue that raises red flags is an elevated pulse rate. Elderly patients with a pulse rate greater than 90 beats a minute were at increased risk of having poor outcomes post discharge. With that in mind, these patients should also be monitored closely.

How to respond

Making sure your ED providers are on the lookout for these warning signs in elderly patients is critical to keeping them from unnecessary readmissions or significant declines in health.

It could be helpful to offer your ED doctors specific training in elder care – especially regarding the warning signs of mental decline, and how to assess and interact with patients who might be experiencing issues with cognition.

Even providers who don’t work in the ED may benefit from similar training, as they should also be closely monitoring and communicating with their elderly patients to ensure the best outcomes.

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