The effect of daily meteorological parameters on the number of emergency service admissions by young and elderly patients

Abstract

AimThe aim of this study was to investigate the effect of daily meteorological parameters on the number of emergency department admissions of older adults.MethodsThis research was designed as a retrospective study. A list of all patients admitted to the emergency room between December 31, 2011 and January 01, 2021 was retrieved from the hospital records. Daily admissions to the emergency department and daily meteorological parameters were compared.ResultsLinear regression analysis revealed a significant correlation between the number of female patients aged 18–65 years admitted to the emergency service and the mean daily temperature (p<0.001) and mean daily relative humidity (p=0.029). According to the results of linear regression analysis, a significant correlation was found between the number of male and female patients aged ≥65 years admitted to the emergency service and the mean daily temperature.ConclusionIn particular, emergency service admissions of men and women aged ≥65 years show a positive correlation with the increase in temperature.

Keywords

Introduction

For most of the 20th century, the population growth of individuals aged ≥65 years exceeded that of other age groups. Owing to this demographic shift and changes in lifestyle, health, and medical developments, the elderly population continues to grow.¹
Multiple comorbidities, multiple drug use, functional and cognitive impairments, and frequent admissions to the hospital with mild clinical signs and symptoms of acute disease and causing difficulties in rapid triage and diagnosis are serious challenges for emergency service workers caused by elderly patients. It has been reported that elderly patients constitute 12% - 24% of all emergency service admissions worldwide.²
Studies have shown that daily meteorological parameters affect many diseases of all ages, and further research is ongoing on this subject. Similarly, studies have reported that elderly patients are affected by meteorological parameters for many reasons.^3-4 Most of these studies have focused on the effect of heat waves. These studies report a relationship between high ambient temperatures and morbidity based on the number of hospitalizations or emergency room visits.^5-6-7 In addition, older adults are reportedly more sensitive to high ambient temperatures, especially heat waves.^8-9
Therefore, the aim of this study was to investigate the effect of daily meteorological parameters on the daily number of admissions to the emergency services by elderly patients.

Materials and Methods

This research was designed as a retrospective study. Ethical approval was obtained from the university ethics committee (2022/12 - 14). A list of all patients admitted to the emergency room between December 31, 2011 and January 01, 2021 was retrieved from the hospital records. Patients were divided into age groups (18 - 65 years and ≥65 years). The relationship between the number of emergency service admissions according to age groups and sex of 151931 patients aged 18 - 65 years (70691 women and 81240 men) and 23331 patients aged ≥65 years (12504 women and 10827 men) and daily meteorological parameters was investigated. Since trauma patients younger than 18 years are also evaluated in the general emergency service in our center, patients aged <18 years were excluded from the study. In addition, outpatients with suspected COVID-19 were also excluded from the study.Meteorological DataDaily average temperature (in degrees Celsius), daily average atmospheric pressure (in millibars), daily average relative humidity (in percentage), and maximum wind speed (in meters per second) between 01 January 2012 and 31 December 2021 were obtained from the Ministry of Environment, Urbanization and Climate Change, the General Directorate of Meteorology, the 13th Regional Directorate.Ethical ApprovalEthics Committee approval for the study was obtained.Statistical AnalysisData were analyzed using SPSS 21.0 (IBM Corporation, Armonk, NY, USA) and University licensed Microsoft Excel packaged software. Numerical data were expressed as mean ± SD and qualitative data in percentage. Paired t-test was used to evaluate the differences in the number and rates of patients admitted to the emergency service per day, month, and season. Pearson correlation analysis was performed to investigate the correlation between the number of patients admitted to the emergency service and meteorological parameters. Linear regression analysis was subsequently performed.

Results

A total of 216,898 patients were admitted to the emergency service in a one-year period. 10.8% (n = 23331) of these patients were aged ≥65 years. It was determined that 53.6% of the patients aged ≥65 years were women (n = 12504) and 46.4% were men (n = 10827).
The highest number and rate of emergency admissions for both female (15.5%) and male (14.9%) patients aged 18 - 65 years occurred on Sundays. In these patients, no significant difference was found between the rates of admission to the emergency services with respect to days of the week and sex (Table 1). In female patients aged 18 - 65 years, the highest rate of emergency service admissions occurred in December (10.6%, n = 7486). Furthermore, number of emergency service admissions in January was significantly higher in male (6.3%) patients compared to female (5.1%) patients aged 18 - 65 years (p=0.021). No difference was found between the number of emergency service admissions by male and female patients in the other months (Table 1).
When seasonal admissions were evaluated, it was determined that the highest number of admissions occurred in Autumn for female (29%) and male (30.6%) patients aged 18 - 65 years. In addition, the rate of emergency service admissions in spring season was significantly higher in female patients (26.8%) than that of male patients (20.4%) aged 18 - 65 years (p<0.001). However, the number of male patients who applied to the emergency service was higher than that of female patients in summer and autumn (Table 1).
Among patients aged ≥65 years, 15.3% (n = 1911) of emergency service admissions occurred on Sundays for female patients. For males of the same age group, the day of the week with the most emergency service admissions was Wednesday with a rate of 14.7% (n = 1596). No difference was found between emergency service admission rates of patients aged ≥65 years with respect to the days of the week and patient sex (Table 1). Among patients aged ≥65 years, the month with the most emergency service admissions was September for women (9.5%, n = 1185) and July for men (9.7%, n = 1049). No significant difference was found between the rates of admission to the emergency service by months of the year and sex of patients aged ≥65 years (Table 1). The season with the most emergency service admissions was autumn for both male and female patients aged ≥65 years. During autumn, 28.0% (n = 3496) of female patients and 28.2% (n = 3058) of male patients were admitted to the emergency service. No significant difference was found between the rates of emergency service admissions according to the seasons of the year and sex of patients aged ≥65 years (Table 1).
A positive correlation was found between the number of female patients aged ≥65 years who applied to the emergency service and daily mean temperature (r = 0.168, p=0.001). A negative correlation was found between the number of female patients aged ≥65 years who applied to the emergency service and daily mean relative humidity (r = −0.113, p=0.031). No significant correlation was found with mean daily mean atmospheric pressure (p=0.427) and daily maximum wind speed (p=0.314). A positive correlation was found between the number of male patients aged ≥65 years who applied to the emergency service and daily mean temperature (r = 0.160, p=0.002). A positive correlation was found between the number of male patients aged ≥65 years who applied to the emergency service and daily mean relative humidity (r = −0.105, p=0.044). No significant correlation was found with mean daily mean atmospheric pressure (p=0.440) and daily maximum wind speed (p=0.486).
Linear regression analysis revealed a significant correlation between the number of female patients aged 18 - 65 years admitted to the emergency service and mean daily temperature (p<0.001) and mean daily relative humidity (p=0.029). In addition, a significant correlation was found between the number of male patients aged 18 - 65 years admitted to the emergency service and mean daily temperature (p<0.001) and daily maximum wind speed (p=0.020) (Table 2). According to the results of linear regression analysis, a significant correlation was found between the number of male and female patients aged ≥65 years admitted to the emergency service and mean daily temperature (Table 3).

Discussion

Based on the results of the present study, it was determined that daily temperature had an effect on the number of emergency service admissions by male and female patients aged ≥65 years.
Studies around the world show an increase in emergency service admissions of patients aged ≥65 years. In a study conducted in Thailand, Lumjeaksuwan et al. reported that patients aged 60 - 107 constituted 28.67% of all emergency service visits.¹⁰ Ukkonen et al.¹¹ reported that patients aged ≥80 years constituted 15% of all emergency service admissions. In general, it has been reported that elderly patients constitute 12% - 24% of all emergency service admissions worldwide.² In the present study, 10.8% of the patients who applied to the emergency service over a one-year period were elderly patients aged ≥65 years. In addition, it was determined that the most emergency service admissions by patients aged ≥65 years occurred in Autumn (29.8%) and Summer (27.3%), in October (10.3%), and on Sundays (14.9%). Gulacti et al. analyzed the data of 36,369 patients aged ≥65 years who applied to the emergency service over a one-year period and reported that the season and month with the highest number of admissions was winter with a rate of 25.9% and January with a rate of 10.2%, respectively.¹² When elderly individuals do not use the ambulance system, they need other people to assist them in hospital examinations, which may cause an increase in the number of emergency service admissions on Sunday.
Climate changes and extreme temperatures create further risks on human health and well-being. Furthermore, certain groups such as children, pregnant women, people with chronic diseases, individuals with low income, and the elderly are more at risk of being affected by heat waves and cold weather.^13-14 Due to this risk, there may be a positive correlation between the number of emergency service admissions by elderly patients and air temperature. Loenhout et al.⁵ showed that the increase in temperature in summer is associated with a sudden increase in emergency department admissions. Similarly, Knowlton et al. reported an increase in emergency service admissions during heat waves.⁶
There are many mechanisms and risk factors through which older people are affected by heat. Decreased thermoregulation is one of these factors.^13,15 Under normal conditions, when body temperature rises, the hypothalamus activates mechanisms that prevent temperature increase and decrease body temperature, such as inhibition of shivering, renal and splanchnic vasoconstriction, peripheral vasodilation, increased heart rate, and increased sweating. However, age-related changes in physiology and other accompanying factors put the elderly at high risk for dysfunction of the thermoregulatory system.¹⁵ An increase in the number of emergency service visits of elderly patients in hot weather may be due to the aggravation of their diseases caused by the deterioration of this balance.
Another reason for the increase in the number of emergency service visits, especially in elderly patients, may be an increase in age-related chronic dehydration.^16-17 When fluid loss exceeds fluid intake, dehydration leads to elevated serum osmolality, which is common in elderly individuals.¹⁸ Studies have found that residents of long-term care facilities (which include residential care, long-term nursing care, and dementia care units) are particularly susceptible to developing dehydration, as they are more likely to experience cognitive and physical problems. In addition, the physiological effects of aging are further complicated by reduced thirst and the body’s capacity to maintain an effective water balance.¹⁶
There may also be an increase in the number of emergency service admissions during the summer months due to the effect of the weather and reduced physical activity in older adults.¹⁹ Previous studies in Canada and the USA show that winter is the most dormant season of the year.^20-21 Jones Gr et al.¹⁹ reported a significant positive correlation between physical activity of the elderly and maximum ambient daytime temperature, and a negative correlation between physical activity and humidity. A further decrease in activity and mobility in the winter months may have led to a decrease in both emergency service admissions and conditions caused by outdoor activities such as trauma.^8,22 Furthermore, an increased sensitivity to high temperatures has been shown among patients with cardiovascular diseases, diabetes, and psychiatric disorders. The increase in the incidence of these diseases with age may also be a reason for the increase in emergency service admissions in elderly patients at higher temperatures.
Extreme heat-related deaths have been reported in both men and women in different studies; however, it has been reported that older women are more severely affected by extreme heat in general.^8,23-24 In the present study, it was determined that emergency service admissions of patients aged ≥65 years did not differ according to sex. However, it was determined that the rate of emergency service admissions in spring was significantly higher in female patients (26.8%) compared to male patients (20.4%) aged 18 - 65 years. In contrast, the number of male patients who applied to the emergency service was higher than the number of female patients in the summer and autumn seasons.

Limitations

There are certain limitations of this study. The main limitation of the study is that it was conducted in a single center. In addition, since the analysis was based on the number of emergency service admissions, individual diseases were not taken into account. For this reason, diseases that are particularly affected by daily meteorological parameters could not be identified.

Conclusion

Emergency service admissions are affected by daily meteorological parameters in every age group. In particular, emergency service admissions of men and women aged ≥65 years show a positive correlation with the increase in temperature.

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