ER Trips Often Point to Larger Health Problems for Older Patients

Twice a day, the 86-year-old man went for long walks and visited with neighbors along the way. Then, one afternoon he fell while mowing his lawn. In the emergency room, doctors diagnosed a break in his upper arm and put him in a sling.

Back at home, this former World War II Navy pilot found it hard to manage on his own but stubbornly declined help. Soon overwhelmed, he didn’t go out often, his congestive heart failure worsened, and he ended up in a nursing home a year later, where he eventually passed away.

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“Just because someone in their 70s or 80s isn’t admitted to a hospital doesn’t mean that everything is fine,” said Timothy Platts-Mills, M.D., codirector of geriatric emergency medicine at the University of North Carolina School of Medicine, who recounted the story of his former neighbor in Chapel Hill.

Quite the contrary: An older person’s trip to the ER often signals a serious health challenge and should serve as a wake-up call for caregivers and relatives.

Research published in the Annals of Emergency Medicine underscores the risks. Six months after visiting the ER, older adults were 14 percent more likely to have acquired a disability — an inability to independently bathe, dress, climb down a flight of stairs, shop, manage finances or carry a package, for instance — than those of the same age with a similar illness, who didn’t end up in the ER.

These older adults weren’t admitted to the hospital from the ER; they returned home after their visits, as do about two-thirds of older adults who go to ERs, nationally.

The takeaway: Illnesses or injuries that lead to ER visits can initiate “a fairly vulnerable period of time for older persons” and “we should consider new initiatives to address patients’ care needs and challenges after such visits,” said one of the study’s coauthors, Thomas Gill, M.D., a professor of medicine (geriatrics), epidemiology and investigative medicine at Yale University.

Research by Cynthia Brown, M.D., a professor and division director of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham, confirms this vulnerability. In a 2016 report, she found sharp declines in older adults’ “life-space mobility” (the extent to which they get up and about and out of the house) after an ER visit — which lasted for at least a year without full recovery.

“We know that when people have a decline of this sort, it’s associated with a lot of bad outcomes — a poorer quality of life, nursing home placement and mortality,” Brown said.

Why would seeking help in an ER often become a sentinel event, with potential adverse consequences for older adults?

Experts offer various suggestions: Older adults who previously were coping adequately may be tipped into an “I can’t handle this any longer” state by an injury or the exacerbation of a chronic illness, such as diabetes or heart failure. They now may need more help at home than what is available, and their health may spiral downward.