Emergency department presentations of older patients in Germany: high rates of ambulatory care–sensitive conditions and increased odds of inpatient mortality in patients living with dementia

BACKGROUND: The crowding of emergency departments (ED) in Germany and many other countries has been a well-known problem and the ageing population is posing additional and very specific challenges to EDs as older patients may present with multimorbidity, polypharmacy, frailty, dementia and non-specific complaints. The primary aim of this study was to characterize clinical and demographic features of emergency department (ED) patients aged ≥70 years in Germany, and to analyse their outpatient care utilization before the ED visit. The secondary aim was to explore the relationship between dementia and inpatient mortality. METHODS: Routine hospital data from 16 German EDs from 2016 were linked to outpatient care data from 2014 to 2017. The demographic and clinical characteristics of ED patients ≥70 years were evaluated for the four billing quarters preceding the first ED visit in 2016. The relationship between dementia and inpatient mortality was assessed using a directed acyclic graph and a generalized linear mixed model adjusted for confounders (e.g., age, sex, comorbidities) and ED centre. RESULTS: In 2016, 99,858 patients aged ≥ 70 years presented to one of the 16 EDs. Most arrived via medical transportation (60.5%). Whilst 31.2% were triaged as less urgent, 64.2% were admitted as an inpatient. Among the most common ED diagnoses were several ambulatory care–sensitive conditions (ACSC). Although 84.1% of patients having had regular contact (i.e., in ≥ 3 billing quarters) with a general practitioner, geriatric assessment was only conducted in 45.7% of patients; 60.2% of ED patients were taking five or more medications (polypharmacy). ED patients with dementia (n = 14,511) had increased odds of inpatient mortality (adjusted odds ratio 1.18; 95%-confidence interval 1.08–1.28). CONCLUSION: The frequent occurrence of ACSC and non-urgent conditions in the ED highlights the need for adequate primary healthcare services for acute medical conditions in Germany, particularly for older patients.