240 Association Between the Elderly Frequent Attender to the Emergency Department and 30-Day Mortality: A Retrospective Study Over 10 Years

Abstract

BACKGROUND:To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality. METHODS:Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student t-test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender.RESULTS: 1.381 million attendance records were analyzed. Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking at 10.2% in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year.CONCLUSION: Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.

Audiologists should not fail with falls: A call to commit to prevention of falls in older adults

“…(Stucki, Bickenbach, Gutenbrunner, & Melvin, 2018, p. 309) (Italicised by author) Globally, falls are a serious economic and public health concern (Haddad, Bergen, & Florence, 2019). Injurious falls present a significant morbidity and mortality threat to the lifespan from early infancy (Alonge & Hyder, 2014) to young, middle (Verma et al, 2016) and late adulthood (Shen et al, 2017). A fall describes an individual unintentionally and involuntarily moving towards the ground or other lower level (Lima, Ricci, Nogueira, & Perracini, 2018), which is not the result of a major intrinsic event or hazard (Lamb, Jørstad-Stein, Hauer, & Becker, 2005).…”