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Yi-Yen Karen Kee, Catherine Rippingale, The prevalence and characteristic of patients with ‘acopia’, Age and Ageing, Volume 38, Issue 1, January 2009, Pages 103–105, https://doi.org/10.1093/ageing/afn238
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Extract
SIR—‘Acopia’ is a pejorative term used in hospitals to describe patients who are unable to cope with activities of daily living. Although the term is not a recognised English word or disease entity, it is becoming increasingly common for older patients to be triaged as ‘acopia’ on admission to the Accident & Emergency (A&E) department.
Australian studies have shown that the term is mainly used to describe either patients with no acute medical problems or who are deemed inappropriate admissions [1, 2].
Older patients identified as being ‘social admissions’ are known to have a significantly higher risk of death or increased dependence [3]. Richardson showed that the presence of a ‘social problem’ was more strongly associated with death or increased dependence than cardiac failure [1].
This study aims to assess the frequency of the usage of the term ‘acopia’ in a district general hospital in the UK and to determine the characteristics of these patients.
Comments
Dear Sir,
It is unfortunately relatively common to find patients labeled with the diagnosis of ‘acopia’, so I was somewhat surprised to find that in the study by Kee and Rippingale (1), less than 0.2% of admissions had this diagnosis. This can perhaps be explained in that their retrospective cohort was based on A&E triage. I am confident that had they scanned the subsequent clerkings and differential diagnosis, the incidence of ‘acopia’ would be greater.
I disagree with their recommendation that ‘acopia’ should be accepted as a cry for help and be recognised as a geriatric syndrome. As the government pushes forward the dignity agenda and the BGS embraces ‘Behind Closed Doors’, we should be enthusiastically advocating removal of derogatory terminology.
‘Acopia’ speaks more about the knowledge and attitude of the doctor referring the patient than the patient's underlying but undiagnosed pathology. Acquiescence to an ingrained pejorative term would be silent acknowledgement that the elderly do not deserve comprehensive assessment and holistic care.
Instead, we should review these cases with our medical students, junior and senior colleagues, demonstrate the missed diagnosis and discuss ways in which these patients can be treated with equity. Only then will the older patient get the assessment and investigation they deserve.
References
1. Kee YY, Rippingale C. The prevalence and characteristic of patients with 'acopia'. Age Ageing. 2009 Jan;38(1):103-5.
Conflict of Interest:
None declared