• 
• 

Three Part Question

In [elderly patients attending the ED] is there a [difference in outcome (including patient satisfaction, time to assessment, morbidity, mortality and re-attendance rates)] between [native language speakers] and [non-native language speakers].

Clinical Scenario

You are asked to attend to an 82 year old foreign language speaking female patient presenting with a 3 hour history of chest pain. She has multiple comorbidities and is quite distressed at having been brought to the hospital. She speaks very limited English, making it almost impossible to take a detailed history. You wonder if this language barrier might influence her management and outcome.

Search Strategy

Pubmed, start of records - Jul 2016

("aged"[MeSH Terms] OR "aged"[All Fields] OR "elderly"[All Fields]) AND ("emergency service, hospital"[MeSH Terms] OR ("emergency"[All Fields] AND "service"[All Fields] AND "hospital"[All Fields]) OR "hospital emergency service"[All Fields] OR ("emergency"[All Fields] AND "department"[All Fields]) OR "emergency department"[All Fields]) AND "languages"[All Fields]) OR "language"[All Fields] OR "language"[MeSH Terms]) LIMITED to human AND english

Search Outcome

471 papers found on the initial search. Of these, 2 papers were relevant to the questions and of sufficient quality to be included.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Njeru JW 2015 USA	1892 patients, representing 40 different languages, requiring interpreting service (IS), compared to the same number of patients not requiring this service (non-IS)	Retrospective cohort study	Risk of at least 1 ED visit	30% higher for LEP patients aged >64	Number of elderly patients (age >64 y) was not clearly shown in this study. Retrospective study. Relied on medical records. The use of interpreter service as a proxy for LEP is incomplete and represents only a subset of patients who truly have LEP
			Risk of at least 1 Hospitalization	20-70% higher for LEP patients aged >64 (unadjusted to adjusted hazard risk)
Mahmoud I 2014 Australia	828 adult patients, 28% of them of a non-English speaking background (NESB): 37 NESB patients aged >64	Cross-sectional survey	No results for the group aged >64. Only overall results presented as different components of satisfaction (staff skills, communication, time with doctor, promptness, etc.)	NESB patients were significantly less satisfied than ESB patients.	Results reflect all age groups and are only indicative and not conclusive.

Comment(s)

There is very limited evidence showing that foreign-language elderly patients attending the ED receive less care than native language attendees. One cohort study found that elderly patients with limited English proficiency were more likely to revisit ED and are at higher risk of hospitalization compared to an age matched English-speaking cohort. None of studies focused exclusively on the elderly population.

Clinical Bottom Line

There were no studies assessing satisfaction, diagnostic accuracy, morbidity or mortality in elderly patients with limited English proficiency (LEP) in the ED. Furthermore, none of the studies found in this search were conducted in the United Kingdom. More research is needed in this area.

References

1. Njeru, J.W., St. Sauver, J.L., Jacobson, D.J., Ebbert, J.O., Takahashi, P.Y., Fan, C. and Wieland, M.L. Emergency department and inpatient health care utilization among patients who require interpreter services BMC Health Services Research
2. Mahmoud, I., Hou, X.-Y., Chu, K., Clark, M. and Eley, R. Satisfaction with emergency department service among non-English-speaking background patients Emergency Medicine Australasia