Elderly flocking to emergency departments after delaying treatment during pandemic 

Elderly flocking to emergency departments after delaying treatment during pandemic 

'We saw people who showed up a week after having a stroke or three or four days after a heart attack,' Dr Fergal Hickey, consultant in emergency medicine at Sligo hospital, said.

Already swamped hospital emergency departments are seeing a spike in older people with serious conditions which have worsened because they delayed seeking treatment during the pandemic.

The Irish Association for Emergency Medicine (IAEM) has demanded the rollout of dedicated rapid access clinics in general medicine and surgery in a bid to reduce the current congestion in EDs.

Figures from the HSE show there were 23,792 ED attendances for the week ending July 25, up 20% on the same period last year, and up 11% when compared to the same period in 2019.

The 3,279 over 75s who presented to EDs in that same week was 18% higher than during the same period last year and 15% higher than the same week in 2019.

Dr Fergal Hickey, consultant in emergency medicine at Sligo hospital and spokesman for the IAEM, said the increased ED attendances were being driven by a rise in genuinely sick people, falls and injuries, delayed presentations and people who have “given up” trying to get through to their GPs.

“Many of those are elderly people who realise the wheels have come off the wagon. They are people who have chronic conditions, like chronic kidney disease, and weren’t getting their regular services or supports [during the lockdown],” he said.

Now their chronic condition has deteriorated. They're running into crisis.” 

Dr Hickey said there were also people who delayed presenting to hospital during the worst of the pandemic, though it was less frequent than in previous waves.

“We saw people who showed up a week after having a stroke or three or four days after a heart attack,” he added.

Holidays exacerbating overcrowding

Holidays within Ireland have exacerbated the overcrowding in EDs, with an increase in injuries as a result of falls from mountains, cliffs, piers and trampolines, he added.

There were 217 people on trolleys as of 8am on Friday morning, 154 of whom were in EDs, according to the latest trolleywatch figures from the Irish Nurses and Midwives’ Organisation (INMO).

The cyberattack is also continuing to have "massive impacts" on the hospital system, Dr Hickey said, with this impact combined with increased demand resulting in many EDs struggling with the patient workload.

 HSE chief Paul Reid said hospital services have been under a lot of pressure. Picture: Leon Farrell / Photocall Ireland
HSE chief Paul Reid said hospital services have been under a lot of pressure. Picture: Leon Farrell / Photocall Ireland

HSE chief executive Paul Reid said hospital services have been under a lot of pressure.

“There is significant reporting of delayed presentations – people who didn’t present themselves during Covid. And a significant proportion of those presentations are from older people needing, in most cases, high acute care,” he said.

That has significant pressures on our hospital system because [older people] have a much longer length of stay. That’s what we’re seeing of late. Older, more frail people who have delayed care coming through.” 

A spokesman for Health Minister Stephen Donnelly told the Irish Examiner that people with illnesses should always seek medical attention at the earliest opportunity, but that does not always mean presenting at an ED.

"People should not delay if they are sick," he said.

Mental health services

The impact of the pandemic is also being seen on the Child and Adolescent Mental Health Services (CAMHs) and eating disorder treatment facilities, according to Dr Anne O’Connor, chief operations officer at the HSE.

HSE figures show there were 258 referrals to Ireland’s three specialist eating disorder treatment hubs in the first six months of this year, which is more than the 228 recorded throughout 2020.

Meanwhile, there has been a further increase in the number of Covid-19 patients in hospitals, up nine to 169 on Friday morning. Of those, 23 were in ICU.

An additional 1,501 cases of the virus were reported on Friday.

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