Salvi Fabio, Morichi Valeria, Grilli Annalisa, Giorgi Raffaella, Spazzafumo Liana, Polonara Stefano, De Tommaso Giuseppe, Rappelli Alessandro, Dessì-Fulgheri Paolo
Department of Internal Medicine, University "Politecnica delle Marche," Ancona, Italy.
J Am Geriatr Soc. 2008 Nov;56(11):2131-8. doi: 10.1111/j.1532-5415.2008.01991.x.
The current disease-oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). In a secondary analysis of a prospective observational cohort of 200 acutely ill elderly patients presenting to two urban EDs in Ancona, Italy, identifiers and triage, clinical, and social data were collected and the following outcomes considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Death, functional decline, any ED revisit and any hospital admission were also considered as a composite outcome. Odds ratios and 95% confidence intervals (CIs) were calculated. Overall, GED patients were older and frailer than CED patients. The two EDs did not differ in terms of early, late, or frequent ED return or in 6-month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22-0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care.
当前以疾病为导向的急诊护理模式无法充分满足前往急诊科（ED）就诊的老年人的复杂需求。有人主张设立具有特定组织形式的专用急诊科设施（例如老年急诊科（GED））。本文描述了世界上为数不多的老年急诊科经验之一，并将其结果与传统急诊科（CED）的结果进行了比较。在对意大利安科纳市两家城市急诊科的200名急性病老年患者的前瞻性观察队列进行的二次分析中，收集了标识符、分诊、临床和社会数据，并考虑了以下结果：早期（30天）和晚期（6个月）急诊科复诊、频繁急诊科返回、住院以及功能衰退。死亡、功能衰退、任何急诊科复诊和任何住院也被视为综合结果。计算了优势比和95%置信区间（CI）。总体而言，老年急诊科患者比传统急诊科患者年龄更大、身体更虚弱。两家急诊科在早期、晚期或频繁急诊科返回、6个月住院或功能衰退方面没有差异。老年急诊科患者的死亡率略低但具有显著差异（风险比=0.47，95%CI=0.22-0.99，P=0.047）。数据表明老年急诊科系统在老年人急性护理方面不劣于传统急诊科，并且间接显示出略有优势，支持了为老年人专门设计的急诊科设施可能提供更好护理的假设。
