Admissions to the emergency department (ED) increased from 2008 to 2019 in Singapore, particularly in the older adult population, reports a study.
“This highlights the growing care needs of older patients and underscore the importance of geriatric-friendly EDs and evidence-based programmes to ensure high-quality care,” said the researchers, who obtained data on ED visits, admission, patient characteristics, and principal ED diagnosis from the electronic health records (EHR) of a tertiary hospital.
Trends were assessed using the Wilcoxon rank-sum test, while the factors associated with ED admissions (primary endpoint) and proportions of high-acuity visits (secondary endpoint) and the interaction between year ang age group were examined using multivariable logistic regression.
The number of ED visits dropped from 108,838 in 2008 to 102,890 in 2019, but the rate of ED admission rose from 35.1 percent to 47.0 percent. [Singapore Med J 2026;67:241-248]
The decrease in the number of ED visits could have been driven by the opening of additional EDs in the Singapore General Hospital (SGH) catchment area in 2010 and 2015, according to the researchers. [JMIR Res Protoc 2022;11:e34201]
Fluctuations
Older adults aged ≥80 years showed a higher increase in ED admissions than adults aged 18‒64 years over time. The same period from 2008 to 2019 also saw an increase in the proportion of high-acuity ED visits across all age groups, but age-related differences diminished over time.
Moreover, there were some fluctuations seen in the most common ED diagnoses. Specifically, diagnoses of general symptoms decreased while fever diagnoses increased from 2016.
“The reasons are potentially two-fold. First, the EHR system at SGH began using SNOMED CT* to code ED diagnoses in 2015. It is possible that some fever cases were coded under general symptoms before this change. Second, ED visits and admissions by older adults, especially those aged ≥80 years, increased significantly during the study period,” the researchers said.
Previous studies observed that older adults most often complained about fever in the ED. [J Am Geriatr Soc 2013;61:12-17; J Am Geriatr Soc 2013;61:12-17; JAMA Network Open 2023;6:e2250423]
“Therefore, the increase in fever cases might be due to the increase in older patients in the ED,” the researchers said. “Nonetheless, further research using more recent data is needed to assess changes in disease presentation, especially among older adults.”
Care models
The researchers also suggested the need for new models of care due to the increasing trend of ED use among older adults. These care models could enhance overall healthcare delivery for this population and enable healthcare systems to adapt to the challenges of an ageing population.
In 2018, the American College of Emergency Physicians introduced a new accreditation programme that recognizes and standardizes geriatric emergency training, aimed at improving care for older adults in the ED. Since that time, an increase has been noted in the number of accredited geriatric EDs in the US. [J Appl Gerontol 2020;39:871-879; J Appl Gerontol 2020;39:871-879]
There is currently no official accreditation for geriatric EDs in Singapore, but many healthcare systems have built infrastructure to enable emergency medicine physicians to collaborate with geriatricians when caring for older adults in the ED.
“Nonetheless, additional efforts are needed to promote geriatric-friendly EDs through research and clinical practice, such as the development and implementation of evidence-based, person-centred screening tools for common geriatric syndromes such as delirium, falls, and polypharmacy,” the researchers said. [J Geriatr Emerg Med 2022;3:10 17294/2694-4715.1041]
Overall, the findings from the current study highlight a connection between an ageing population and increased ED utilization among older adults.
“As the population ages in Singapore and globally, geriatric-friendly EDs represent a crucial adaptation of healthcare systems to meet evolving demographic needs,” the researchers said.
*Systematized Nomenclature of Medicine Clinical Terms