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

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. 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. 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). 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.