The progressive ageing of the Italian population represents one of the main challenges for contemporary healthcare systems. According to ISTAT 2025 data, the Ageing Index has reached 207.7 individuals over 65 for every 100 young people under the age of 14, marking a significant increase compared to the previous year. Infectious diseases in the elderly population deserve particular attention: symptoms may be absent or atypical, making early diagnosis complex. Factors such as ageing, immunosenescence, the presence of comorbidities, or geriatric syndromes contribute to the increased vulnerability of this population and the increased frequency of emergency department visits. The study aims to describe the clinical and demographic characteristics of 65- and over-aged patients who present with an infectious disease to the ED. The goal is to improve understanding of this patient group and optimise clinical management, diagnostic-therapeutic pathways, and long-term results. A single-centre retrospective observational study was conducted in a cohort of 1,176 elderly patients (≥65 years) who attended the Policlinico di Modena ED in March 2023; of these, 171 with an infectious disease were selected for analysis. Data, including age, sex, diagnosis code, discharge diagnosis, length of stay in the ED (LOS), Charlson's comorbidity index and institutionalisation status, were extracted from medical records and hospital databases in pseudonymized form. The analysed sample (mean age 80.10 ± 8.53 years; 57% female) displayed a profile of high clinical complexity, with a mean CCI of 5.44 ± 2.29. Respiratory conditions represented the most frequent diagnostic group (54%), followed by sepsis (16%). Admitted patients (n=96) were significantly older (p<0.05), with no sex predominance, and had a higher comorbidity index compared to discharged patients (p<0.05). The triage code proved to be a significant predictor of hospital admission (p<0.001): the "major-code/minor-code" variable was the only statistically significant independent predictor (OR 0.10; 95% CI 0.04–0.23; p<0.001). The data show that 85% of major-code patients were admitted, whereas among minor-code patients the proportion drops to 30.7%. Analysis of the discordance between triage code and discharge outcome identified an under-triage rate (subjects assigned a White, Green, or Blue code who were subsequently admitted) of 30.77%; of these, 26 were assigned a Blue code and 2 a Green code. The type of infection showed no significant association with outcome (all ICD-9 groups had p>0.05). Analysis of concordance between the disease category assigned at triage and the final ICD-9 diagnosis revealed agreement in 51,72% of cases (Pearson's Chi-squared test: χ²=243.87, df=48, p<2.2×10⁻¹⁶), suggesting a systematic discrepancy between clinical classification at presentation and definitive diagnosis. The lowest agreement was assessed in the septic patient; 13 patients were evaluated, and a 100% discrepancy was excluded from the study. The categories with the highest agreement were found to be Gastrointestinal and Dermatology, while the categories with the lowest agreement were Genitourinary (k=0.45) and Respiratory (k=0.49). Five confounding factors were assessed: diabetes mellitus, CKD, tumor, dementia, and ACCI score. This study contributes to characterising the elderly population with infectious diseases attending the ED. The results suggest the need to tailor triage and care pathways specifically for the geriatric patient with infection, to reduce the risk of underestimating the severity of the disease and improve the appropriateness of admission decisions.
L'invecchiamento progressivo della popolazione italiana rappresenta una delle principali sfide per i sistemi sanitari contemporanei. Secondo i dati ISTAT 2025, l'Indice di Vecchiaia prevede 207,7 anziani over 65 ogni 100 giovani fino ai 14 anni, con un aumento significativo rispetto all'anno precedente. Le malattie infettive nella popolazione anziana meritano particolare attenzione: i sintomi possono essere assenti o atipici, rendendo complessa la diagnosi precoce. Fattori quali l’invecchiamento, l'immunosenescenza, la multicomorbidità e la presenza di sindromi geriatriche contribuiscono ad aumentare la vulnerabilità di questa fascia di popolazione e la frequenza degli accessi ai servizi di emergenza. Il presente studio si propone di descrivere le caratteristiche cliniche e demografiche della popolazione over 65 che accede al PS con una malattia infettiva, al fine di migliorare la comprensione di questo gruppo di pazienti e contribuire all'ottimizzazione della gestione in triage, dei percorsi diagnostico-terapeutici o degli outcome a lungo termine. Lo studio è monocentrico, retrospettivo, osservazionale, condotto su una coorte di 1176 pazienti anziani transitati al PS del Policlinico di Modena nel mese di marzo 2023, di questi ne sono stati selezionati 171 con patologia infettiva. I dati, comprensivi di età, sesso, codice triage, diagnosi di dimissione, durata della permanenza in PS (LOS), Charlson Comorbidity Index (CCI) e stato di istituzionalizzazione, sono stati estratti dalle cartelle cliniche e dai database ospedalieri in forma pseudonimizzata. Il campione analizzato (età media 80,10 ± 8,53 anni; 57% femmine) ha mostrato un profilo di elevata complessità, con un CCI medio di 5,44 ± 2,29. Le patologie respiratorie hanno rappresentato il gruppo diagnostico più frequente (54%), seguite dalle sepsi (16%). I pazienti ricoverati (n=96) erano significativamente più anziani (p<0,05), senza prevalenza per il sesso e con indice di comorbidità più elevato rispetto ai dimessi (p<0,05). Il codice triage si è confermato un predittore significativo dell'esito di ricovero (p<0,001): la variabile "codice maggiore / codice minore" è risultata l'unico predittore indipendente statisticamente significativo (OR 0,10; IC 0,04–0,23; p<0,001). I dati mostrano che l’85% dei codici maggiori viene ricoverato mentre nei codici minori la percentuale scende al 30,7%. L’analisi della discordanza tra codice di triage ed esito di dimissione ha rilevato un “under-triage” (soggetti con codice minore poi successivamente ricoverati) del 30,77%; tra questi, 26 pazienti con codice Azzurro e 2 con codice Verde. Il tipo di infezione non mostra un'associazione significativa con l'esito di dimissione (tutti i gruppi ICD-9 mostrano p>0,05). L'analisi della concordanza tra la categoria di malattia attribuita al triage e la diagnosi ICD-9 finale ha evidenziato un accordo nel 51,72% dei casi (test Chi-quadrato di Pearson: X²=243,87, df=48, p<2,2×10⁻¹⁶), suggerendo una discrepanza sistematica tra la classificazione clinica all'ingresso e la diagnosi definitiva. L’accordo più basso è stato valutato nel paziente settico; 13 pazienti valutati e una discrepanza del 100%, questi sono stati esclusi dallo studio. Le categorie con accordo maggiore sono risultate essere la Gastro-intestinale e la Dermatologia mentre le categorie con accordo minore sono la Genito-urinaria (k=0.45) e la Respiratoria (k=0.49). Sono stati valutati cinque fattori confondenti: diabete mellito, IRC, tumore, demenza e punteggio CCI. Lo studio contribuisce a caratterizzare la popolazione anziana con patologie infettive che accede al PS. I risultati sottolineano la necessità di percorsi di triage e di presa in carico calibrati per il paziente geriatrico con infezione, al fine di ridurre il rischio di sottostima della gravità e migliorare l'appropriatezza delle decisioni di ricovero.
Infectious Diseases in the Older Population: A Retrospective Study
CUOGHI, CAMILLA
2025/2026
Abstract
The progressive ageing of the Italian population represents one of the main challenges for contemporary healthcare systems. According to ISTAT 2025 data, the Ageing Index has reached 207.7 individuals over 65 for every 100 young people under the age of 14, marking a significant increase compared to the previous year. Infectious diseases in the elderly population deserve particular attention: symptoms may be absent or atypical, making early diagnosis complex. Factors such as ageing, immunosenescence, the presence of comorbidities, or geriatric syndromes contribute to the increased vulnerability of this population and the increased frequency of emergency department visits. The study aims to describe the clinical and demographic characteristics of 65- and over-aged patients who present with an infectious disease to the ED. The goal is to improve understanding of this patient group and optimise clinical management, diagnostic-therapeutic pathways, and long-term results. A single-centre retrospective observational study was conducted in a cohort of 1,176 elderly patients (≥65 years) who attended the Policlinico di Modena ED in March 2023; of these, 171 with an infectious disease were selected for analysis. Data, including age, sex, diagnosis code, discharge diagnosis, length of stay in the ED (LOS), Charlson's comorbidity index and institutionalisation status, were extracted from medical records and hospital databases in pseudonymized form. The analysed sample (mean age 80.10 ± 8.53 years; 57% female) displayed a profile of high clinical complexity, with a mean CCI of 5.44 ± 2.29. Respiratory conditions represented the most frequent diagnostic group (54%), followed by sepsis (16%). Admitted patients (n=96) were significantly older (p<0.05), with no sex predominance, and had a higher comorbidity index compared to discharged patients (p<0.05). The triage code proved to be a significant predictor of hospital admission (p<0.001): the "major-code/minor-code" variable was the only statistically significant independent predictor (OR 0.10; 95% CI 0.04–0.23; p<0.001). The data show that 85% of major-code patients were admitted, whereas among minor-code patients the proportion drops to 30.7%. Analysis of the discordance between triage code and discharge outcome identified an under-triage rate (subjects assigned a White, Green, or Blue code who were subsequently admitted) of 30.77%; of these, 26 were assigned a Blue code and 2 a Green code. The type of infection showed no significant association with outcome (all ICD-9 groups had p>0.05). Analysis of concordance between the disease category assigned at triage and the final ICD-9 diagnosis revealed agreement in 51,72% of cases (Pearson's Chi-squared test: χ²=243.87, df=48, p<2.2×10⁻¹⁶), suggesting a systematic discrepancy between clinical classification at presentation and definitive diagnosis. The lowest agreement was assessed in the septic patient; 13 patients were evaluated, and a 100% discrepancy was excluded from the study. The categories with the highest agreement were found to be Gastrointestinal and Dermatology, while the categories with the lowest agreement were Genitourinary (k=0.45) and Respiratory (k=0.49). Five confounding factors were assessed: diabetes mellitus, CKD, tumor, dementia, and ACCI score. This study contributes to characterising the elderly population with infectious diseases attending the ED. The results suggest the need to tailor triage and care pathways specifically for the geriatric patient with infection, to reduce the risk of underestimating the severity of the disease and improve the appropriateness of admission decisions.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14251/6731