Comparing Older Adults Assigned a Low Acuity Triage Score to Their Younger Counterparts in the Emergency Department: A Review of Patient Characteristics and Outcomes

Background Older adults (≥65 years) present to the emergency department (ED) more frequently and have longer lengths of stay in the ED when compared to their younger counterparts. Older adults are also at risk for undertriage in the ED and may require hospital admission or further intervention despite having a “low acuity” triage score. Our study aimed to describe and compare the characteristics, resource utilization, and health outcomes of older adults with “low acuity” triage scores to their younger counterparts in urban EDs in Newfoundland and Labrador (NL). Methods A chart review was performed on older adults (≥65 years) assigned a “low acuity” triage score, defined by the Canadian Triage and Acuity Scale (CTAS) as 4 or 5. Patients aged 40-55 years were selected as controls, serving as younger counterparts to the older adults. The primary outcome was hospital admission at the index ED visit. Secondary outcomes included length of stay in the ED and 14-day ED re-visit rate, among others. Subgroups included those 65-74 years, 75-84 years, and 85 years and older. Results Eight hundred fifty-one (n=851) patients were screened, and 554 were included. The mean age was 78.5 and 46.8 years, respectively, for older adults and controls. Older adults were more likely to arrive by ambulance (19.7% versus 4.8%, p=0.001) and require a social work consultation (5% versus 0%, p=0.028). Hospital admission did not differ between older adults and controls (1.1% versus 0%, p>0.05). Among subgroups, those 85 years and older were more likely to require more testing and interventions, social support services, and hospital admission compared to those <85 years (p<0.05 for all). Conclusions Older adults were more likely to require ambulance services and a social work consultation compared to their younger counterparts. Among older adults, the use of ambulance services, ED resources, and hospital admission was highest among those 85 years and older. The urban EDs in NL should optimize ambulance utilization, expand access to social work and interdisciplinary support, and allocate resources to address the needs of the oldest-old. Implementing targeted care pathways, such as managing musculoskeletal patients with low-acuity CTAS scores through advanced practice providers, may enhance efficiency and reduce unnecessary admissions. Further research is needed to assess the health and economic impact of these strategies and to guide evidence-based planning for older adult care in the EDs.