Research Article: No age thresholds in the emergency department: A retrospective cohort study on age differences

Date Published: January 30, 2019

Publisher: Public Library of Science

Author(s): Caro Fuchs, Bilge Çelik, Steffie H. A. Brouns, Uzay Kaymak, Harm R. Haak, Lars-Peter Kamolz.


Emergency care in elderly patients has gained attention by researchers due to high utilization rate and the importance of emergency services in elderly care. We examine if there is a clear age threshold between young and old patients at which there is a need for extra care and facilities in the emergency department. This retrospective cohort study uses emergency department (ED) data collected over the course of a year, containing information about 31,491 patient visits. The measured variables are treatment time, waiting time, number of tests, number of medical procedures, number of specialties involved and the patient’s length of stay on the ED. To examine the multivariate differences between different patient groups, the data set is split into eighteen age groups and a MANOVA analysis is conducted to compare group means. The results show that older patients tend to have a longer stay on the ED. They also require more medical tests, have higher resource utilization and admission rates to the hospital. When the patients are grouped according to life stages (<18, 18-39, 40-64 and ≥65), each life stage shows significantly different characteristics across all variables. To understand where these differences start, age bins of five years are analyzed and almost none of the consecutive groups are significantly different in any variable. A significant difference between all groups is observed when age interval of the bins is increased to 10 years. This indicates that although age has an effect on the patient’s treatment, a clear age threshold that identifies the group of elderly patients is not observable from emergency room variables. The results of this study show no clear age boundary between young and old patients. In other words, we could not find support for favoring the often-used age boundary of 65 over other boundaries (e.g. 60 or 70) to distinguish the group of elderly patients on the ED.

Partial Text

In 2017, there are an estimated 962 million people aged 60 or over in the world, comprising 13 per cent of the global population, and the population aged 60 or over keeps growing at a rate of about 3 per cent per year [1]. The treatment in the emergency department has a critical role in the elderly care, and successful treatment of acute failures is enabled by identifying the requirements of elderly patients accurately [2].

This study examines the differences in patients according to age and aims to find whether a clear age threshold between young and old patients in the emergency department exists.




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