Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia.
J Emerg Med. 2020 Feb;58(2):339-345. doi: 10.1016/j.jemermed.2019.12.014. Epub 2020 Jan 28.
Every emergency department (ED) faces both a rising tide and a revolving door of elderly patients. Unplanned short-term returns after a recent ED evaluation or hospital admission are sentinel events. Consequences include substantial functional decline, reduced health-related quality of life, and increased risk of dependency or death. Returning families, unaware of the significant likelihood of deterioration after an ED or hospital discharge, often harbor suspicions that something was missed. Literature describing the significant likelihood of functional decline in elderly patients after ED or hospital discharge is presented. Suggestions for incorporating the potential for subsequent deterioration into the evaluation of elderly ED patients and the discussions surrounding disposition decisions are included.
In addition to impacting patients and families, posthospitalization decline and short-term readmissions create serious burdens for hospitals and their EDs. Education, vigilance, specialized geriatric EDs, dedicated inpatient units, and ED access to outpatient services for the elderly can aid in the recognition and mitigation of postvisit functional decline and associated returns. Financial incentives for reducing short-term readmissions can translate into novel approaches and referral arrangements.
Currently, and for the foreseeable future, EDs are integral to predicting, identifying, and preventing functional decline in the elderly. For now, we are all Geriatric EDs.
每家急诊科（ED）都面临着老年患者人数的不断增加和循环。最近在 ED 评估或住院后无计划的短期返回是预警事件。后果包括功能显著下降、健康相关生活质量降低以及依赖性或死亡风险增加。返回的家庭，不知道 ED 或出院后病情恶化的可能性很大，常常怀疑有什么东西被遗漏了。本文介绍了老年患者在 ED 或出院后功能下降的可能性很大。还包括将潜在的后续恶化纳入老年 ED 患者的评估，并围绕处置决策进行讨论。
除了对患者和家庭产生影响外，出院后下降和短期再入院给医院及其 ED 带来了严重负担。教育、警惕、专门的老年 ED、专门的住院病房以及 ED 为老年人提供门诊服务，可以帮助识别和减轻出院后功能下降及相关返回。减少短期再入院的经济激励可以转化为新的方法和转诊安排。
目前，并且在可预见的未来，ED 是预测、识别和预防老年人功能下降的不可或缺的一部分。目前，我们都是老年 ED。
