Abstract
BACKGROUND: Global population aging places an increasing burden on health care systems. This is driven by multimorbidity, frailty, and polypharmacy. Older adults, particularly those aged 65 years or older, use emergency departments (EDs) more frequently and experience poorer outcomes. In this population, decisions regarding admission to monitored acute care units-intensive care units, intermediate care units, and operating rooms-are frequent and complex. While ED and intensive care unit use are well documented, data on monitored acute care units as a whole remain limited. Evidence on admission trends, patient characteristics, and outcomes in older adults is scarce. OBJECTIVE: This study aimed to describe temporal trends in monitored acute care unit admissions, identify predictors of such admissions, and assess outcomes following these admissions. METHODS: We conducted a retrospective cohort study using routinely collected electronic health record data. We included patients aged 65 years or older who visited the EDs of the Geneva University Hospitals, Switzerland, between 2009 and 2019. The primary outcome was admission to a monitored acute care unit. The secondary outcomes were hospital length of stay, 7-day mortality, and 1-year mortality. Logistic regression models were used to identify factors associated with monitored acute care unit admission and to assess the association between age and mortality. RESULTS: During the 10-year period, 701,838 ED visits were recorded. Annual visits increased from 56,944 to 76,368 (+34.1%). The increase was greater among patients aged 65 years or older (+56.1%) than among younger patients (+26.5%). A total of 180,189 older patients presented to the ED. Of these, 887 (0.5%) died in the ED, 97,238 (54.0%) were discharged home, 63,025 (35.0%) were admitted to a ward, and 19,039 (10.6%) were admitted to a monitored acute care unit. Monitored acute care unit admissions increased from 1379 (10.3%) in 2009 to 2240 (11.1%) in 2019. This represented an absolute increase of 62.4% and a relative increase of 0.8%. Predictors of monitored acute care unit admission included younger age, male sex, ambulance arrival, higher triage level, being married or in a relationship, not residing in a nursing home, and French as the primary language. Among patients admitted to a monitored acute care unit, mortality was 5.8% (1105/19,039) at 7 days and 22.3% (4251/18,039) at 1 year. Older age was associated with higher 7-day mortality (adjusted odds ratio 1.55, 95% CI 1.14-2.10) and 1-year mortality (adjusted odds ratio 1.28, 95% CI 1.08-1.51). CONCLUSIONS: Admissions to monitored acute care units among older patients increased over time. These findings indicate a growing demand for high-level care in this population. Hospitals should adapt infrastructure and resource allocation to address the needs of an aging population.