Introduction: Old people attend emergency departments (ED´s) in increasing numbers. Old people have age related changes in all organ systems and tend to have multiple chronic diseases, be on multiple medications and often have physical and cognitive functional impairments. Hence, they have complex health and social service needs. The purpose of this study was to describe function and geriatric syndromes of old people who present at Landspitali Emergency Department, Iceland, with comparison to ED´s in six other countries.

Material and methods: A prospective descriptive study of people (>75 year´s) attending ED´s in seven countries, including Iceland. The InterRAI assessment tool for ED´s was used by nurses to assess participants.

Results: At Landspitali ED, 202 individuals were assessed, of whom 55% were women. Of the 202 individuals, 34% attended the ED within 90 days and of those 48% lived alone. On admission to the ED, 59% had physical or cognitive functional impairment; 13% had only cognitive impairment and 36% were unable to walk without assistance. Caregiver distress was identified in 28% and 11% felt overwhelming burden. From the ED, 46% were admitted to the hospital. Compared with foreign results greater number of Icelandic participants lived alone and caregiver's distress was slightly higher (28% vs. 18%). Fewer individuals in Iceland were admitted to a hospital and Iceland had higher admission rate to rehabilitation compared with the overall group.

Conclusion: Geriatric syndromes and functional impairment afflicted majority of old people who attended the Landspitali ED. These observations should be taken into account in ED design and care planning for old people to maximize efficiency, safety and quality.

Key words: InterRAI ED, old, emergency department, screening tool, outcome.

Correspondence: Pálmi V. Jónsson, palmivj@landspitali.is

Hoskuldsdottir GTh, Geirsdottir OG, Kristjansdottir ID, Johannesdottir H, Benediktsdottir B, Guðjonsdottir B, Magnusdottir I, Runarsdottir S, Jonsson PV on behalf of InterRAI ED  Group

Tables and figures:

Table I: Participants

	All country (N=2282)	Iceland (n=202)
Country; Australia Belgium Canada Germany Iceland India Sweden	283 (12,4%) 385 (16,9%) 532 (23,3%) 549 (24,1%) 202 (8,9%) 98 (4,3%) 233 (10,2%)
Gender (male)	939 (41,2%)	90 (44,8%)
Age (Mean (SD))	83.2 (5,5)	82.7 (4,5)
Living alone	922 (40,6%)	96 (47,8%)
Informal helper feeling stress	378 (18,3%)	46 (27,7%)
Family feeling overwhelming	366 (17,7%)	19 (11,4%)
Admitted from long term care	163 (7,2%)	0 (0%)
No of times used ED in last 90 days; Never Once Twice and more	1468 (64,5%) 518 (22,8%) 290 (12,7%)	132 (65,7%) 47 (23,4%) 22 (10,9%)
Time since last hospital stay; None 31-90 days ago Within last 30 days	1649 (72,5%) 293 (12,9%) 331 (14,6%)	140 (69,6%) 26 (12,9%) 34 (16,9%)

Table II: Functional profile

Premorbid	All country (N=2282)	Iceland (n=201)
Bathing -supervision/ assistance	909 (39,8%)	48 (23,9%)
Personal hygiene - supervision/ assistance	539 (23,7%)	24 (11,9%)
Dressing lower body - supervision/ assistance	649 (28,5%)	26 (12,9%)
Locomotion - supervision/ assistance	586 (25,8%)	37 (18,4%)
Cognitive skills for daily decision making - supervision/ assistance	454 (20,0%)	14 (7,0)
Admission
Bathing -supervision/ assistance	1380 (60,9%)	102 (50,7%)
Personal hygiene - supervision/ assistance	960 (42,3%)	69 (34,3%)
Dressing lower body - supervision/ assistance	1115 (49,1%)	63 (31,3%)
Locomotion - supervision/ assistance	1115 (49,1%)	73 (36,3%)
Cognitive skills for daily decision making - supervision/ assistance	579 (25,5%)	27 (13,4%)
IADL medication - supervision/ assistance	889 (39,1%)	60 (29,8%)

Table III: Outcome

	All country (N=2282)	Iceland (n=202)
Discharged from, to ED; Acute care hospital Other hospitals (including rehabilitation / palliative care Long term care facility Home Community supported care Deceased No information	1364 (60,2%) 72 (3,2%) 46 (2,0%) 685 (30,2%) 90 (4,0%) 8 (0,4%) 17 (0,7%)	91 (45,0%) 3 (1,5%) 0 (0%) 93 (46,0%) 5 (2,5%) 2 (1,0%) 8 (4,0%)
No days at acute care hospital; Mean (range)	7 (0-336)	6 (0-49)
Discharged from acute care hospital;; Other hospitals (including rehabilitation / palliative care Long term care facility Home Community supported care Deceased No information	(n = 1364) 78 (5,7%) 154 (11,3%) 815 (59,7%) 123 (9,0%) 121 (8,9%) 73 (5,3%)	(n=91) 19 (20,9%) 1 (1,1%) 64 (70,3%) 0 (0%) 1 (1,1%) 6 (6,6%)

Figure 1: Function and health at admission to ED