'Disgrace' as 4,000 elderly wait in A&E for 24 hours
'Difficult for families, frustrating for doctors'
It is "completely unacceptable" that more than 4,000 people aged over 75 endured waits of more than 24 hours in crowded hospital emergency departments in the first three months of this year, a leading medical consultant has said.
Long periods spent in noisy casualty departments can cause acute agitation and distress in the vulnerable elderly with cognitive impairment, said Dr Emily O'Conor, president of the Irish Association of Emergency Medicine.
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Dr O'Conor, consultant at Connolly Hospital, Blanchardstown, was responding to figures obtained by Fianna Fail health spokesperson Stephen Donnelly. She said the nationwide situation was difficult for patients and their families and frustrating for doctors and nurses.
HSE figures given to Deputy Donnelly showed 4,349 people aged over 75 had to wait in emergency departments for more than 24 hours between January and March.
Dr O'Conor said it is not known how many elderly were on trolleys and how many were on chairs.
"Overworked nurses in charge of overcrowded departments" must decide who gets a trolley as there are not enough to go around, she said.
"A 75-year-old person in an emergency department for more than 24 hours is completely unacceptable...Tragically, there are a lot of older people who don't have their own advocates coming with them," Dr O'Conor said.
"The environment in the department is difficult. It's bright and noisy and for someone who has cognitive impairment such as dementia, it can cause acute distress and raise the chances of developing delirium. It can be very difficult for a loved one to witness their agitation," she said.
"We try and prioritise them for a bed because the lack of access to the calmer environment of a ward is going to precipitate the onset of delirium."
Emergency departments are seeing large numbers of elderly people, many aged over 85 and 90.
They have many nursing needs as well as medical needs while waiting on trolleys. There is also the important matter of dignity and privacy, she said.
"We feel our professional frustration not being able to deliver the patient care we need. We will have made decisions on a patient 12 hours ago or it could be 24 hours ago. They could have all the medical decision-making done well in advance and they are still in the ED and that brings a separate level of frustration," Dr O'Connor said.
A Frailty Initiative in hospitals seeks to flag the arrival of particularly vulnerable elderly and, if possible, get them access to convalescent or respite beds and outpatient services if an acute hospital bed is not needed. But that initiative does not operate at weekends.
Under the Acute Bed Capacity Review, 2,500 new hospital beds are needed if major change emphasising care in the community is proposed. Otherwise, 7,500 new beds are needed, she said.
"Progress is painfully slow...We need to revolutionise the number of new beds," she said, adding that a political decision is needed.
Deputy Donnelly said the HSE was failing to meet its own target that all attendees aged 75 and over attending Emergency Departments would be discharged or admitted within 24 hours.
"These figures are disgraceful. The lack of bed capacity is a fundamental problem. If the minister can't get to grips with this basic problem, we are going to see thousands more over-75s languishing in A&Es," he said.
Another reason for long waits is that Ireland has only half the number of medical consultants that are needed and a severe shortage of specialist nurses, he said.