Service de post-urgence gériatrique, Hôpital Edouard-Herriot, Lyon
Service de gériatrie, Centre hospitalier Lyon-Sud, Pierre-Bénite
The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors.
An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners.
This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described.
The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness.
This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.