The amount of time people over 80 spend in A&E in England has almost doubled in a year, leaving them at increased risk of coming to harm and dying, emergency care doctors are warning.
An analysis by the Royal College of Emergency Medicine (RCEM) found that people of that age are spending 16 hours in A&E waiting for care or a bed, a huge rise on the nine hours seen in 2021.
The college, which represents the UK’s A&E doctors, warned that long waits, allied to overcrowding in hospitals and older people’s often fragile health, is putting them in danger.
The RCEM found that the length of time people over 60, and especially over 80, now typically stay in an emergency department in England getting treated has spiralled recently as hospitals have increasingly struggled to cope with the surge in demand for care.
A&E doctors fear that older patients are bearing the brunt of the ever-longer NHS-wide waits for emergency medical care and hospital beds, despite many being frail and seriously unwell.
Doctors specialising in emergency and elderly care warned that older people forced to spend a long time in A&E are more likely to suffer a fall, develop sepsis, get bed ulcers or become confused.
Dr Adrian Boyle, the RCEM’s president, said that it is also likely that some older people are dying as a result of the delays they are facing, combined with their often poor underlying health.
The risks older people face while waiting in sometimes chaotic A&E units are so great that they are likely to be disproportionately represented among the 500 people a week who the RCEM estimates are dying as a direct result of delays in accessing urgent medical help.
Age UK said it was horrified being stuck in A&E for so long is putting older patients at risk.
The NHS’s lack of beds forces thousands of patients a month whom doctors have decided to admit to spend hours languishing on a trolley in an A&E corridor waiting for one to become free. A&E staff worry that the difficulty of monitoring them puts them at risk of dying from, for example, a cardiac arrest or loss of ability to breathe.
“Long waits are more harmful to older people than younger ones. This new data confirms that elderly people are waiting longer in emergency departments,” said Boyle.
“This is not how we want to look after our parents and grandparents. Not only is this undignified, but also dangerous. Older people are disproportionately affected by long stays and contribute more to the estimates of excess death that we have previously asserted.
“This may well be contributing to the concerning excess mortality that we have seen in 2022.”
The RCEM compared the total amount of time different age groups spent in A&E in hospitals in England waiting to be seen, admitted, transferred or discharged last year with 2021. This is what emergency doctors call “time in department”.
Younger patients are also facing longer stays in A&E, but have seen those rise gently rather than sharply, the RCEM found. But its analysis of NHS England data showed that the amounts of time faced by everyone aged at least 40, and especially those aged 60 and above, have rocketed.
For example, waits by those under 20 rose from four to five hours between 2021 and 2022. But stays by 60- to 79-year-olds went from eight hours and 20 minutes to 13 hours and 20 minutes. And among those aged 80 or over they shot up from nine hours to 16 hours.
“No older person goes to A&E unless they feel they have no choice, and many are likely to be seriously unwell once they get there,” said Caroline Abrahams, Age UK’s charity director.
“We are horrified that some very old people are then having to wait so long to be seen, jeopardising their health and in the worst cases even their survival. Many are likely to be living with existing serious health conditions, and frailty, so they are in no position to wait for many hours.”
Prof Adam Gordon, the president of the British Geriatrics Society, which represents doctors who look after older people, said: “The RCEM analysis tells us that older people – those aged 70 and above – are facing unacceptably long waits in emergency departments. The risks to older people associated with these waits are substantial.”
Busy, noisy A&Es can lead to older patients becoming confused. Evidence shows that those who do so while in hospital end up staying twice as long and are up to five times more likely to die than those who do not develop confusion.
The Department of Health and Social Care did not respond directly to the RCEM’s analysis and warning.
“We know urgent and emergency care is facing serious challenges but we have an ambitious and credible plan to fix it,” a DHSC spokesperson said. “This week we set out our plan to reduce pressure on hospitals by scaling up community teams and expanding virtual wards, which allow people to be safely monitored from the comfort of their own home. We are also increase capacity with 5,000 more hospital beds as part of the permanent bed base and 800 new ambulances.”
