Here - American Geriatrics Society

P OSTER
A BSTRACTS
351,874 visits to the ED, out of which 63,278 (18%) were of adults
aged 60 and over (A60), while 17,593 (5%) were aged 80 years or
older (A80). There was an increase in 83.2% of elderly visits throughout
the years. It was additionally verified that of the total number of
A60 and A80, respectively 46.1% and 51% were female; 24.5% and
31.9% were admitted to hospital wards (versus 5.4% among patients
aged from 18 to 59 years); and 1.4% and 2.8% died still at the ED or
subsequently during hospital stay (versus 0.4%). The median length
of stay for A60 was 3.1 days at the ED, and 5 days at the hospital
wards (versus 2.5 and 3 days). Injuries and their consequences
(17.8%), symptoms and signs involving the digestive system and abdomen
such as abdominal pain, nausea and vomiting (8.4%), general
symptoms and signs such as fever, syncope and collapse, malaise and
fatigue (5.5%), specific medical procedures and health care actions
(4.7%), acute upper respiratory infections (4.4%) and dorsopathies
(3.5%) were the most common diagnoses, as defined using the ICD-
10 blocks of codes. Conclusion: Older adults are increasingly seeking
care in the ED. They are more frequently hospitalized and have
higher mortality than younger patients who seek care in the same setting.
Injuries and digestive system complaints are the most frequent
motivations for their visits. The high frequency of non-specific symptoms
like malaise, fatigue and fever indicate the need of an expert
team to make the correct diagnoses in this setting.
A55
Nonagenarians: an increasing reality in the emergency room.
T. J. Avelino-Silva, L. A. Gil, A. L. Bierrenbach, C. Toscano, W. Jacob-
Filho, F. Ganem. Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.
Supported By: None of the authors reported a potential, real, or
perceived conflict of interest or financial disclosure. No sponsors
participated in or funded this research.
Background: In Brazil, as in more developed countries, the
strongest growth of the older population shall be in the age bracket
above 80. How does one guarantee an efficient health system and
quality of life for this new mass of older citizens? It was our objective
to better understand the characteristics of the patients over 90 years
of age who seek care in the emergency room. Methods: We retrospectively
reviewed a database containing information of all the patients
who visited the emergency department (ED) of a 350-bed private tertiary
care general hospital in São Paulo, Brazil, from January 2003 to
December 2010. Data pertaining to the patients who were 90 years of
age or older were searched for the following: age; gender; principal
diagnosis (ICD-10 codes); hospital admission; length of stay; and outcome.
Results: Over the 8-year study period, there were 351,874 visits
to the ED, out of which 63,278 (18%) were of adults aged 60 and over
(A60), while 4,099 (1.1%) were aged 90 or older (A90). There was an
expressive growth of the number of older adult visits to the ED
throughout the years (83.2%), but it was the age group over 90 that
showed the most remarkable expansion (95.6%). Of the total number
of A90, 58.1% were female, while only 46.1% were so if one considered
A60. A90 were admitted to hospital wards in 35.1% of the cases
(versus 24.5% for A60), and 4.1% died at the ED or subsequently
during their hospital stay (versus 1.4%). The median length of stay
was 3.1 days at the ED, and 5 days at the hospital wards, which was
similar to younger geriatric patients. Injuries and consequences accounted
for 17.9% of A90 visits. Other important reason for their visits
were specific medical procedures and health care actions (7%).
These were mostly related to surgical and orthopedic follow-up care,
attention to artificial openings, like colonostomy and others and issue
of repeat prescriptions. General symptoms and signs such as fever,
syncope and collapse, malaise and fatigue (6.9%), symptoms and
signs involving the digestive system and abdomen (6.9%), influenza
and pneumonia (6%), and heart diseases (5.4%) followed in frequency.
Conclusion: ED visits by patients over 90 had the greatest increase
among older adults. The primary motivations for their visits
were injuries, specific medical procedures and health care actions.
Further discussion of adequate settings to provide care for these patients
is needed.
A56
Cause of Death among Older Adults with Cognitive Impairment
with and without Dementia: The Aging, Demographics, and
Memory Study.
T. Okura, 1 K. M. Langa. 2 1. Bajikoen Clinic, Tokyo, Japan; 2.
University of Michigan, Ann Arbor, MI.
(Background) Hypothesizing that older individuals with dementia
die from different causes compared to those with the milder levels
of cognitive impairment, we compared the cause of death for those
with dementia to those with normal cognition or cognitive impairment
without dementia (CIND) using longitudinal data from a nationally
representative sample of older adults in the United States.
(Methods) We used data from the Aging, Demographics, and
Memory Study (ADAMS), a sub-study of the Health and Retirement
Study (HRS) focused on cognitive impairment and dementia. We
identified individuals aged 71 or older diagnosed as normal, CIND, or
demented by the ADAMS consensus diagnosis panel. Date and cause
of death during the 9-year study period were obtained from the HRS.
(Results) 91.3% of those with dementia died during the followup
period compared to 67.5% and 28.1% of those with CIND and
normal cognition, respectively. Heart disease was the most common
cause of death across all cognitive categories, accounting for about
25% of deaths in each group. Those with dementia were more likely
to die from stroke (13.5% vs. 4.3% for CIND, 4.6% for normal cognition,
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