JMIR Publications

ABSTRACT

Background:

The aging global population imposes a growing burden on healthcare systems due to increased chronic illnesses, frailty, and polypharmacy. Older adults, especially those over 65, have higher emergency department use and poorer outcomes after intensive care unit admission. Despite substantial data on emergency department and intensive care unit use, limited research exists on monitored acute care units, particularly regarding their trends, roles, and effectiveness in managing older patients.

Objective:

This study aims to describe trends in monitored acute care unit admissions over time, identify predictors of admission, and assess outcomes following monitored acute care unit admission.

Methods:

We conducted a retrospective cohort study using data from patients aged 65 years or older who visited the emergency department between 2009 and 2019. The primary outcome was monitored acute care unit admission, which included intensive care unit, intermediate care units, and operating room. Secondary outcomes included hospital length of stay, 7-day and 1-year mortality. Logistic regression models were employed to identify factors associated with monitored acute care unit admission and to examine the relationship between age and 1-year mortality.

Results:

Among the 180,189 patients ≥65 years old who visited the emergency department over the 10-year study period, monitored acute care unit admissions increased by 62%, with a notable shift from the intensive care unit (41% decrease) to the intermediate care units (220% increase). Predictors of monitored acute care unit admissions included younger age, male sex, arrival by ambulance, higher triage level, marital status, absence of nursing home residency, and French as the primary language. Seven-day and 1-year mortality among monitored acute care unit patients were 5.8% and 22.3%, respectively.

Conclusions:

This study highlights the increase in monitored acute care unit admissions among older patients, driven primarily by the rise in intermediate care unit admissions. These findings underscore the growing demand for high-level care and emphasize the need for hospitals to adapt healthcare infrastructure, procedures, and resource allocation to meet the needs of an aging population.