Diagnostic Difficulties and Factors Affecting Diagnosis in Acutely Ill Elderly Japanese Patients Living at Home

Abstract

Summary: Background: Home visits by primary care physicians to elderly patients in Japan have increased as part of a government initiative to relieve pressure on acute care hospitals. However, there is evidence of discrepancies between diagnoses in the primary care and hospital settings. Methods: We conducted a retrospective cross-sectional study using two years of medical records from a primary care center to investigate diagnostic accuracy of acutely ill elderly patients in the primary care setting, and reasons for emergency hospital admissions. We analyzed data from all cases where extra home visits were needed due to acute illness, and used inferential statistics to compare initial diagnosis with final diagnosis and analyze the factors affecting diagnostic accuracy. Results: We analyzed 591 cases (mean age of patients: 85 years). The most common reasons for emergency hospitalization were respiratory, gastrointestinal, or cardiovascular diseases. There was a significant difference in initial diagnostic accuracy between respiratory diseases, gastrointestinal diseases, and other conditions (p = 0.005); an accurate diagnosis was likely for respiratory diseases but unlikely for gastrointestinal diseases. Polypharmacy (≥8 medications) was associated with low diagnostic accuracy on multivariable logistic regression analysis (odds ratio, 0.24; 95% confidence interval, 0.06–0.67; p = 0.006). Conclusion: Primary care providers should note subtle symptoms and the number of medications taken, provide follow-up, and consider gastrointestinal diseases when making a diagnosis following acute changes in an elderly patient. Keywords: acute illness, diagnosis, elderly, polypharmacy, primary care