The human body was designed to last about 50 years but most of us expect to live well beyond that. Life expectancies in Bermuda are about 72 years for men and 79 years for women. This is good news as we get to spend more time with loved ones but it also impacts areas you would not readily think of.

The increase in the elderly population is the main reason waiting times in the Emergency Ward have increased. The longest waiting times are about two-and-a-half-hours at King Edward VII Memorial Hospital (KEMH). And the prediction is that these waits will get even longer.

“This is not just in Bermuda. It’s happening in hospitals in the US and the rest of the developed world,” said Director of Emergency Services at KEMH, Dr. Edward Schultz. “Human beings were designed to live until they are about 50 years old,” he said. “But over the last few decades, advances in medical care and technology are seeing people live much longer than that.

“Advances in the treatment of certain cancers, for example, have greatly extended lives and this is a good thing,” he said.

But it’s not a totally rosy picture. Oftentimes these people develop or are at risk for other conditions.

Dr. Schultz said the elderly are the fastest growing segment of the community. They also form the fastest growing segment of patients seen in the Emergency Ward. And their conditions are the most complicated and often the most life threatening.

“They are more prone to chronic diseases,” said Dr. Schultz. This through the natural process of ageing and through neglect in managing their health.

Dr. Schultz said older patients in the Emergency Ward tend to be sicker and take more time to service.

This has a knock-on effect where other patients in Emergency have to wait for the very sick elderly to be attended to, before they can be treated.

There is a formal triage system in place at KEMH, the Emergency Severity Index, which ensures that the sickest patients are seen in the least amount of time. But the elderly are causing a backlog.

Many come in with chest pain. “To exclude a heart attack we have to do two blood tests, six hours apart,” said Dr. Schultz. “This means a bed is occupied for at least six hours, maybe eight. If we have a few of these patients it can significantly slow down our ability to attend to less critical patients.”

And the blood tests are not the only tests likely to be carried out on elderly people complaining of chest pain.

It is the complexity of ailments affecting elderly patients that extend the amount of time they have to spend in Emergency. For example Dr. Schultz said cancer patients are usually seen in Emergency when they have developed an infectious disease. This is often because the immune system has been weakened by chemotherapy.

“These patients will take a greater amount of time to assess and process,” said Dr. Schultz. “Although they maybe living longer with cancer, they may be at increased risk for deep vein thrombosis and blood clot formation because of their underlying condition as well as some of their medications. They may need anti-coagulants (to prevent the blood from clotting).

“Many have to be admitted as we cannot complete the treatment they need, in the Emergency,” he said. “This impacts on the bed status of the hospital.”

And when the general wards are full, these patients are held in Emergency tying up beds there and slowing down the ability to attend to less acute patients.

Many of the elderly seen in Emergency are there because they have simply neglected their health.

“We frequently see patients who have had no preventative maintenance. Who don’t get their blood pressure and blood sugar checked and develop complications as a result,” Dr. Schultz said.

“Many patients know they have diabetes but don’t go to their doctor and don’t take their insulin. We see the same thing with lung disease and smoking. So that we get patients with chronic lung disease — emphysema — and they are still smoking.”

Dr. Schultz said the elderly patient load in Emergency could be cut significantly if local residents paid good attention to their health and regularly visited their doctors.

“Patients have a huge role in controlling their outcomes,” he said.

He admitted that some patients are lax in seeing their doctors because they cannot afford it but said that some people are just determined not to comply. Still others get confused not really understanding their disease or their medication.

“Many of these people have several tablets to take a day and it’s a fact that the more tablets they are supposed to take, the less likely they are to take any of them, because it becomes confusing,” he said.

Still it is important that people take charge of their health. “And even if they do everything right there will be times they get acute exacerbations and need to see us,” he admitted.

The most common conditions he sees in elderly patients attending the Emergency Ward are:

[bul] High blood pressure;

[bul] Type 2 diabetes;

[bul] Hypertension;

[bul] Chronic lung disease;

[bul] Heart attack;

[bul] Stroke.