Trends in the Age Distribution of Emergency Room Patients

Findings of a Retrospective Longitudinal Study

The increasing proportion of older persons within the total population is a central aspect of demographic change in Germany. In 1991, 15% of the population were aged 65 or older, whereas by 2022 it had risen to 22%. For the coming years and decades, further increases of this population group are expected.

Older people are disproportionally over-represented in emergency departments. In combination with rising patient numbers and age-related particularities in geriatric patients (1) this represents a central challenge for clinical emergency care in Germany for the coming years.

This study aimed to analyze trends in the age structure in a university hospital emergency department over a time period of 11 years.

Methods

In a retrospective longitudinal study, we recorded all patient contacts in the time period from 1 January 2014 to 31 December 2024 in the central interdisciplinary emergency department at University Hospital Regensburg. Because of structural changes in acute neurology care during the data collection period, patients with neurological lead symptoms were excluded from the analysis over the entire study period. No relevant changes occurred in the emergency care structure in the regions. Because of the particular circumstances during the COVID-19 pandemic, we excluded the time period 2020/2021 (2).

We used the software package KNIME (version 5.3) to analyze anonymized patient data. To measure the resource requirements we added up at the case level all documented nursing or medical activities in the emergency department (for example, vascular accesses, dressings, diagnostics). Administration of medications was recorded separately. We used JMP (version 18.0.2) and Jamovi (version 2.6.45.0) for the statistical analysis.

The study received ethics approval from the ethics committee at Regensburg University. No ethical or legal concerns existed against carrying out the research project (approval: 25–4243–104).

Results

In the study period, a total of 345 361 patient contacts took place in the emergency department at Regensburg University Hospital. Having excluded patients whose main symptoms were neurological (n=10 066) and patient contacts during the COVID-19 pandemic 2020/2021 (n=53 168) we analyzed 282 127 cases (Table). The case volume increased by 19.4% during the observation period. Patients’ mean age rose continually—except for the period of the COVID-19 pandemic 2020/2021: from 45.0 (95% confidence interval: [44.8; 45.3] years in 2014 to 47.3 [47.1; 47.6] years in 2024. In parallel, the proportion of persons aged 65 or older rose from 22.8% [22.6; 23.1] to 26.0 [25.8; 26.3] (Figure). The increase in the group of people aged 85 or older was particularly pronounced, at 55%, from 3.07% [2.96; 3.19] to 4.76% [4.63; 4.89]. An age of 65 years or older was associated with a higher priority in the initial assessment, shorter waiting times to start of treatment, a longer stay in the emergency department, a higher hospital admission rate, more administrations of medication, and a higher resource requirement.

Figure

The changing age structure in an emergency department between 2014 and 2024. The years of the COVID-19 pandemic 2020/2021 are summarized separately. Because of rounding errors the percentages do not sum exactly.

Table

Characteristics of patient contacts

In patients aged 65 or older, the frequency of emergency department consultations at University Hospital Regensburg per year increased: persons younger than 65 made a mean of 1.12 [1.12; 1.13] emergency department visits per year, persons aged ≥65 years, by contrast, attended emergency departments 1.18 [1.18; 1.18] times a year. The proportion of patients with 2 or more visits per year was also higher in the age group ≥65 years (11.20% [10.93; 11.47]) than in those younger than 65 (7.83% [7.70; 7.95]).

Discussion

Emergency care in older persons is notably different from that in younger people: older people are over-represented compared with the population. They are admitted to hospital more often, need more resources, have longer stays, and constitute a greater priority (1). Furthermore, geriatric patients more commonly have several co-existing health problems and atypical presentations of pathologies, which render making a diagnosis more complex (3).

In view of the demographic change in Germany, this study analyses for the first time long-term data regarding trends in the age structure of a German emergency department in a university (maximum care) hospital. Over the 11-year study period the mean patient age increased by 2.3 years. The proportion of patients aged ≥65 years rose by 14.0%; in the age group of very old people aged ≥85 years, the relative increase was 55.0%. This trend corresponds with earlier observations from other countries with comparable demographic developments (4). Of note is the fact that the mean age of the population in the hospital’s catchment area increased over the same time period by only 0.8 years; the proportion of persons aged ≥65 years rose by 9.4% (from 18.1% to 19.8%) and of persons aged 85 or older by 26.1% (from 2.3% to 2.9%). The demographic change therefore disproportionally affects the age structure in the hospital emergency department. In addition to a higher probability of becoming ill at an advanced age and a greater life expectancy, additional factors may contribute to this trend, such as a reduction in home visits or the declining primary care capacity.

Older people require more resources in the emergency department (5); they have longer stays and are admitted to hospital more often. A disproportionate increase in resource requirements in emergency departments and hospitals is to be expected and will need to be considered in future staffing, structural (standard operating procedures [SOPs], quality management, specialized care strategies, management of delirium), and financial plans in order to ensure efficient hospital emergency medical care that clinically as well as humanely does justice to all patients.

Julian Hupf, Sophie Schlosser-Hupf, Constantin Maier-Stocker, Markus Zimmermann

Universitätsklinikum Regensburg, Abteilung für Klinische Akut- und Notfallmedizin (Hupf, Maier-Stocker, Zimmermann), [e-mail]

Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin I (Schlosser-Hupf)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 14 July 2025, revised version accepted on 22 December 2025.
Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Hupf J, Schlosser-Hupf S, Maier-Stocker C, Zimmermann M: Trends in the age distribution of emergency room patients: Findings of a retrospective longitudinal study. Dtsch Arztebl Int 2025; 122: 175–6. DOI: 10.3238/arztebl.m2025.0243

References

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