Acopia‘: a Useful Term or Not?

Background : ‘Acopia’, meaning inability to cope, is increasingly used by Australian public hospital emergency departments to describe frail older patients. This raises concerns among geriatricians that significant medical illnesses in older people are being misdiagnosed or under diagnosed Objective : An audit was conducted to determine the medical status and outcomes of patients admitted with ‘acopia’ at two Sydney teaching hospitals. Methods : A retrospective audit of medical records of patients admitted with ‘acopia’ from July 1996 to June 1998 at Royal North Shore Hospital and Nepean Hospital NSW was carried out. Results : A total of 109 patients were assigned the ‘diagnosis’ of ‘acopia’ in the emergency department. 64% were female. 104 files were available for review. The 100 patients aged 65 years or more were reviewed in detail. Mean age was 80 +/‐ 10 years. The term ‘acopia’ was used mostly by senior emergency department staff. Multiple medical problems were present, especially gait disorder and dementia. The average number of medical diagnoses per patient was 8.0. Most patients were independent in activities of daily living (52%) and were living in the community (74%) prior to becoming medically unwell. The main reasons for admission were the geriatric syndromes of gait disorder, falls, confusion and incontinence. Average length of stay was approximately 13 days. Only 50% of patients were able to return home; 25% required nursing home placement. Three percent died in hospital and advanced cancer was newly diagnosed in 5%. Conclusions : We conclude that ‘acopia’ is not a useful term in that most patients labeled as such have multiple medical problems as the reason for their admission. The use of the term may result in reduced awareness of the need to seek out and treat reversible pathology in older patients. This study highlights the need for ongoing training for emergency department staff in the recognition and management of patients with geriatric syndromes.