Spending the night in an emergency room puts older adults at higher risk of dying in the hospital: study

Some patients who have to spend a night in the emergency room before being admitted to the hospital may face a higher risk of dying there, according to a new study in JAMA Internal Medicine.

Researchers in France assessed statistics from 97 different emergency departments across the country between Dec. 12-14, 2022, focusing on patients who were older than age 75.

They compared patients in two different groups: those who were admitted to a regular hospital room before midnight, and those who had to spend a full night in the ER before they were given a room. 

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The latter group was more likely to die in the hospital within 30 days (15.7% vs. 11.1%).

They were also more likely to have adverse health outcomes, including falls, infection, bleeding, myocardial infarction, stroke, thrombosis (blood clots), bedsores and dysnatremia (low sodium levels).

Patients who required assistance with daily functions were at the highest risk, the study authors stated.

The risk potentially could extend beyond the ER. 

In a separate 2022 study, researchers from Penn State and University of California, San Francisco found that the hospital-wide mortality rate was 5.4% higher on days when the emergency room was crowded.

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Kenneth J. Perry, M.D., an emergency physician at Trident Medical Center in Charleston, South Carolina, was not involved in the study but offered his input on the findings.

“This study is not surprising for anyone who works in health care at all,” he told Fox News Digital in an email. 

The issue with emergency care is multifaceted, Perry noted. 

“First, patients cannot be turned away from the emergency department before being cared for due to EMTALA (Emergency Medical Treatment and Active Labor Act), the federal law that codified the responsibilities of hospitals even without payment,” he said. 

This means that patients can keep coming into the hospital even when there aren’t enough beds to accommodate them, the doctor noted.

“All hospitals in the U.S. have experienced some level of ‘admit holds’ in the ED over the past few years,” he added.

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No matter the location, elderly patients can be vulnerable in the health care environment, Perry also said.

“From presbyopia (nearsightedness of aging), which makes low-light areas difficult for them to see, or possible cognitive deterioration, the ED can be scary, confusing and possibly dangerous,” the doctor warned. 

“Patients can possibly get up to use the bathroom, but not have the ability to see where they are going — or fall over the items in the room that they are not used to having around them,” he went on. 

“There is also the possibility of the development of delirium. This stems from the fact that the stimulation of the ED environment can completely skew day and night and create confusion in the patients.”

“From insurance reform to more robust primary care, the problems are so large that the system does not have any easy fixes.”

Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, who was also not involved in the research, agreed that the findings aligned with his expectations.

“There is more that can potentially go wrong with older adults in the emergency room,” he told Fox News Digital.

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“Older patients may have less medical reserve and more comorbidities (other medical issues) — and they could become more easily stressed and disoriented, which can worsen outcomes,” Siegel added.

“It’s also easier to pick up additional medical problems in the hospital, including infections,” he said.

So what needs to change?

Solving the emergency room bottleneck would require multiple changes, Perry said. 

“From insurance reform to more robust primary care, the problems are so large that the system does not have any easy fixes.”

The doctor emphasized the importance of family members serving as advocates for patients and ensuring that the environment is safe. 

Perry also noted that the blame doesn’t lie with the medical staff.

“The nurses, doctors and other staff in the ED also would appreciate your family member getting a bed upstairs,” he said. “They are not the ones that are keeping the system from functioning better.”

Siegel said hospitals need to take these risks into consideration and be “problem-oriented.”

“Hospitals are more likely to discharge elderly patients from the ER once the problem has been addressed and they are stable,” he said. 

“Granted, there are times when we need to observe elderly folks longer to make sure something isn’t evolving, but we must be aware of the additional risks of keeping them for observation as well.”

Fox News Digital reached out to the French study authors for additional comment.

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