Impact of the COVID-19 pandemic on demand for emergency department care for older patients: the EDEN-7 COVID cohort study
F. Javier Montero-Pérez1, Ángela María Cobos Requena1, Juan González del Castillo2, Javier Jacob3, Eric Jorge García-Lamberechts2, Pascual Piñera Salmerón4, Aitor Alquézar-Arbé5, Sira Aguiló6, Cesáreo Fernández Alonso2, Guillermo Burillo-Putze7, María Calderón Caro1, Ángel Iván Díaz Salado8, Enrique Martín Mojarro9, Patricia Eiroa-Hernández7, Patricia Parra-Esquivel10, Juan José López Pérez4, Martín Ruiz Grinspan11, Ivet Gina Osorio Quispe6, Matilde González Tejera12, Leticia Serrano Lázaro13, Begoña Espinosa Fernández14, Lidia Fuentes3, Coral Suero Méndez15, María del Valle Toro-Gallardo16, Fahd Beddar Chaib17, Paula Pedraza Ramírez18, Òscar Miró6 (en representación de los investigadores de la red SIESTA).
Affiliation of the authors
1Emergency Department, Hospital Hospital Universitario Reina Sofía, Córdoba, Spain. 2Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain. 3Emergency Department, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain. 4Emergency Department, Hospital Reina Sofía, Murcia, Spain. 5Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. 7Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain. 8Emergency Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain. 9Emergency Department, Hospital Santa Tecla, Tarragona, Spain. 10Emergency Department, Hospital Norte Tenerife, Tenerife, Spain. 11Emergency Department, Hospital University Hospital del Henares, Madrid, Spain. 12Emergency Department, Hospital General Universitario de Elche, Alicante, Spain. 13Emergency Department, Hospital Universitario y Politécnico La Fe,Valencia, Spain. 14Emergency Department, Hospital General Universitario Dr. Balmis, Alicante, Spain. 15Emergency Department, Hospital Axarquia, Velez-Malaga, Spain. 16Emergency Department, Hospital Regional de Málaga, Spain. 17Emergency Department, Hospital Santa Barbara, Soria, Spain. 18Emergency Department, Hospital Valle Pedroches, Pozoblanca, Córdoba, Spain.
Montero-Pérez FJ, Cobos Requena AM, González del Castillo J, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Alquézar-Arbé A, Aguiló S, et al. Impact of the COVID-19 pandemic on demand for emergency department care for older patients: the EDEN-7 COVID cohort study. Emergencias. 2023;35:279-8
Summary
Objective.
To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period.
Methods.
Retrospective cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic.
Results.
The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P < .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More resources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%).
Conclusions.
The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.
