• Eur. J. Intern. Med. · Jun 2023

    Older patients with nonspecific complaints at the Emergency Department are at risk of adverse health outcomes.

    • C S van Dam, M J L Peters, E O Hoogendijk, NanayakkaraP W BPWBAmsterdam UMC, Vrije Universiteit Amsterdam, Section General Internal Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands., M Muller, and M C Trappenburg.
    • Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, De Boelelaan 1117, Amsterdam, the Netherlands. Electronic address: c.vandam@amsterdamumc.nl.
    • Eur. J. Intern. Med. 2023 Jun 1; 112: 869286-92.

    ObjectiveOlder adults at the Emergency Department (ED) often present with nonspecific complaints (NSC) such as 'weakness' or 'feeling unwell'. Health care workers may underestimate illness in patients with NSC, leading to adverse health outcomes. This study compares characteristics and outcomes of NSC-patients versus specific complaints (SC) patients.MethodsCohort study in patients ≥ 70 years in two Dutch EDs. NSC was classified according to the BANC-study-framework based on the medical history in the ED letter, before additional diagnostics took place. A second classification was performed at the end of the ED visit/hospital admission. Primary outcomes were functional decline, institutionalization, and mortality at 30 days.Results26% (n = 228) of a total of 888 included patients presented with NSC. Compared with SC-patients, NSC-patients were older, more frail, and more frequently female. NSC-patients had a higher risk of functional decline and institutionalization at 30 days (adjusted ORs 1.84, 95% CI 1.27 - 2.72, and 2.46, 95% CI 1.51-4.00, respectively), but not mortality (adjusted OR 1.26, 95% CI 0.58 - 2.73). Reclassification to a specific complaint after the ED visit or hospital admission occurred in 54% of NSC-patients.ConclusionNSC occur especially in older, frail female patients and are associated with an increased risk of functional decline and institutionalization, even after adjustment for worse baseline status. In half of the patients, a specific complaint revealed during ED or hospital stay. Physicians at the ED should consider NSC as a red flag needing appropriate observation and evaluation of underlying serious conditions and needs of this vulnerable patient group.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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