Prevalence of Nonmedical Problems Among Older Adults Presenting to the Emergency Department

Objectives Health outcomes among older emergency department (ED) patients may be influenced by physical, economic, and psychological problems not routinely identified during the ED visit. The objective of this study was to characterize such problems among older adults presenting to the ED. Methods This was a prevalence study with enrollment during 4-hour periods randomly selected between 9 a.m. and 9 p.m. on random days of the week over a period of 8 weeks at an academic ED in the southeast United States. Participants were noninstitutionalized, cognitively intact adults aged 65 years or older without life-threatening illness or injury. Consenting patients were asked about the frequency of 10 prespecified problems during the past year. Results Patients (N = 138) were non-Hispanic white (69%) and female (57%) and almost all had primary providers (95%) and health insurance (98%). Forty percent reported their overall health as fair (21%) or poor (19%). Hazardous drinking habits were reported by 10% of patients. The prevalence of problems occurring either “sometimes” or “often” in the past year were pain (60%), difficulty walking (47%), lack of money (32%), isolation and loneliness (14%), lack of transportation (12%), difficulty scheduling a doctor's appointment (4%), difficulty getting prescriptions filled (4%), and lack of dental care (6%). Nine patients (7%) reported experiencing physical or psychological abuse at some point in the past year. Females, minorities, and individuals living in urban areas reported higher rates of most problems. Conclusions Nonmedical problems are common among cognitively intact, independent living, non–critically ill older patients presenting to an ED in the southeast United States. Resumen Objetivos Los resultados de salud en los pacientes mayores del servicio de urgencias (SU) pueden estar influidos por problemas fisicos, economicos y psicologicos que no son identificados rutinariamente durante la visita al SU. El objetivo de este estudio fue caracterizar estos problemas en los adultos mayores que acuden al SU. Metodologia Estudio de prevalencia que incluyo pacientes durante periodos de 4 horas seleccionados aleatoriamente entre las 9 a.m. y las 9 p.m. en dias de la semana durante un periodo de 8 semanas en un SU universitario del sureste de Estados Unidos. Los participantes fueron adultos de 65 anos o mas cognitivamente intactos, no institucionalizados y sin lesiones o enfermedades potencialmente mortales. Se pregunto a los pacientes que firmaron el consentimiento informado por la frecuencia durante el ano de diez problemas prespecificados anterior. Resultados Los pacientes (N = 138) fueron predominantemente blancos no hispanos (69%), mujeres (57%), y casi todos tenian un proveedor principal (95%) y un seguro medico (98%). Un 40% documento su salud global como justa (21%) o mala (19%). Se documentaron habitos alcoholicos de riesgo en un 10% de los pacientes. La prevalencia de problemas que ocurrieron tanto “a veces” como “a menudo” en el pasado ano fueron: dolor (60%), dificultad para caminar (47%), falta de dinero (32%), aislamiento y soledad (14%), falta de medio de transporte (12%), dificultad para concertar una cita con el medico (4%), dificultades para obtener medicamentos con receta (4%) y falta de cuidado dental (6%). Nueve pacientes (7%) documentaron haber experimentado abusos fisicos o psicologicos en algun momento del pasado ano. Las mujeres, las minorias y los individuos residentes en areas urbanas documentaron porcentajes mas altos de la mayoria de los problemas. Conclusiones Los problemas no medicos son comunes entre los pacientes mayores no enfermos de gravedad, cognitivamente intactos e independientes para la vida diaria que acuden a los SU en el sureste de Estados Unidos.