Medical emergencies and comorbidities in the elderly and very elderly patients in North India

Abstract

Objective: Older patients are rapidly increasing in the emergency department in low-middle-income countries and have poor outcomes. The present study aimed to find the spectrum of comorbidities, medical emergencies, and prognosis in geriatric patients and compare the elderly with very elderly patients in North India. Methodology: A prospective cohort study was conducted on patients aged ≥60 years admitted at Postgraduate Institute of Medical Education and Research, Chandigarh (India). The elderly and very elderly age was defined as 60–74 years and ≥75 years, respectively. Results: Of 935 enrolled patients, 763 (81.6%) were elderly, and 172 (18.4%) were very elderly. Very elderly more frequently required admission in the red area (65.7% vs. 57.4%, P = 0.045). 85.2% (n = 796) of patients had preexisting comorbidities, hypertension (44.5%) and diabetes (34.8%) being the most common. The most comorbidities and the Charlson comorbidity index score distribution were similar to the two age groups; however, hypertension was more in the elderly (52.3% vs. 42.7%, P = 0.022). Overall, gastrointestinal (25.7%), neurological (20.7%), and cardiovascular (19.0%) emergencies were common; however, the very elderly patients more frequently had neurological illnesses (30.8% vs. 18.5%, P < 0.001). Pulmonary infections were the most prevalent infections in both age groups. The frequency of urinary tract infections was higher in the very elderly (17.5% vs. 6.1%, P = 0.023). In-hospital survival was 82.7% (n = 773) and significantly low in the very elderly (76.7% vs. 84.0%, P = 0.023). The survival was predicted by quick sequential organ failure assessment but not by the Charlson comorbidity index. Conclusion: Very elderly patients more frequently have hypertension, neurological emergencies, urinary tract infections, and poor outcomes.