Care of the elderly in the emergency department

Lowenstein, Steven R.; Crescenzi, Caroline; Kern, Donald C.; Steel, Knight

doi:10.1016/s0196-0644(86)80987-8

Cited by 172 publications

(103 citation statements)

References 33 publications

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“…Western studies are also beginning to focus their attention on elderly patients presenting at the EDs, as they recognize that they require more assistance, time, and expertise, putting a strain on limited ED resources. [28][29][30][31] Following this study, we are planning for the identification and right-siting of vulnerable patients through an integrated care management system (ICMS). ICMS is built on the general framework of targeted case management program.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Boh

Finkelstein

et al. 2015

Academic Emergency Medicine

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Objectives: This study aimed to determine which factors contribute to frequent visits at the emergency department (ED) and what proportion were inappropriate in comparison with nonfrequent visits.Methods: This study was a retrospective, case-control study comparing a random sample of frequent attenders and nonfrequent attenders, with details of their ED visits recorded over a 12-month duration. Frequent attenders were defined as patients with four or more visits during the study period.Results: In comparison with nonfrequent attenders (median age = 45.0 years, interquartile range [IQR] = 28.0 to 61.0 years), frequent attenders were older (median = 57.5 years, IQR = 34.0 to 74.8 years; p = 0.0003). They were also found to have more comorbidities, where 53.3% of frequent attenders had three or more chronic illnesses compared to 14% of nonfrequent attenders (p < 0.0001), and were often triaged to higher priority (more severe) classes (frequent 52.2% vs. nonfrequent 37.6%, p = 0.0004). Social issues such as bad debts (12.7%), heavy drinking (3.3%), and substance abuse (2.7%) were very low in frequent attenders compared to Western studies. Frequent attenders had a similar rate of appropriate visits to the ED as nonfrequent attenders (55.2% vs. 48.1%, p = 0.0892), but were more often triaged to P1 priority triage class (6.7% vs. 3.2%, p = 0.0014) and were more often admitted for further management compared to nonfrequent attenders (47.5% vs. 29.6%, p < 0.001). The majority of frequent attender visits were appropriate (55.2%), and of these, 81.1% resulted in admission. For the same number of patients, total visits made by frequent attenders ($174,247.60) cost four times as much as for nonfrequent attenders ($40,912.40). This represents a significant economic burden on the health care system.Conclusions: ED frequent attenders in Singapore were associated with higher age and presence of multiple comorbidities rather than with social causes of ED use. Even in integrated health systems, repeat ED visits are frequent and expensive, despite minimal social causes of acute care. EDs in aging populations must anticipate the influx of vulnerable, elderly patients and have in place interventional programs to care for them.ACADEMIC EMERGENCY MEDICINE 2015;22:1025-1033 by the Society for Academic Emergency Medicine C are at the emergency department (ED) is usually focused on acutely ill patients facing life-threatening conditions. Worldwide, EDs have faced problems of overcrowding, long patient wait times, and admission bed blocks related to increasing numbers of patients.1-7 ED visits in Singapore's seven public hospiFrom the Duke-NUS Graduate

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Section: Discussionmentioning

confidence: 99%

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Boh

Finkelstein

et al. 2015

Academic Emergency Medicine

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“…12 socioeconomic characteristics; 6,18 influence of family opinion; 6 limited access to primary care, 6 availability of services in hospital; 19,20 lack of self care; 6,21 and a lack of social supports. 12,22,23 Our understanding of the importance of these factors in terms of EDs arises from analyses of older people's presentation to EDs regardless of triage category.…”

mentioning

confidence: 99%

The ‘unnecessary’ use of emergency departments by older people: findings from hospital data, hospital staff and older people

Faulkner

Law

2015

Aust. Health Review

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Objective. Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations.'Methods. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period.Results. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals.Conclusions. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.What is known about the topic? Increasing demands are being placed on hospital emergency departments and there are concerns that a growing number of presentations are 'inappropriate presentations'. Older people are considered to be one group that overuse emergency department services. What does this paper add? Most studies use hospital statistics to examine primary care presentations at emergency departments or present the viewpoints of medical staff within hospitals about the necessity of these visits. This paper compares and contrasts the available data from hospitals, the opinions of medical and allied health professionals and information collected from older people themselves to provide greater insight into why older people triaged as three, four or five attend emergency departments in Adelaide. What are the implications for practitioners? For a range of reasons including availability of quality care, familiarity with hospital services, and a lack of community based services, older people will continue to present to emergency departments. With increasing numbers of older people in the population, hospital emergency departments will need to continuously adapt to accommodate the needs of this older demographic and for staff to acquire necessary geriatric skills.Additional...

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“…Functional impairment at the time of the emergency visit predicts a poor medical outcome at three weeks (Denman 1989). Functional impairment before the onset of the illness responsible for the visit predicts readmission to the hospital within two weeks (Lowenstein 1986). Functional status is a stronger predictor of length of stay in hospital, mortality, and nursing home placement than is the principal admitting diagnosis (Narain 1988).…”

Section: Introductionmentioning

confidence: 99%

“…Functional status is a stronger predictor of length of stay in hospital, mortality, and nursing home placement than is the principal admitting diagnosis (Narain 1988). On discharge from the emergency department, older people are more likely to report a decline in their ability to care for themselves, with an increasing number needing help with personal care, housekeeping and income assistance (Lowenstein 1986, Rosenfeld 1990, Rowland 1990). However, Hedges (1992) reports that an assessment of self-care is not done in most older patients presenting to the emergency department.…”

Section: Introductionmentioning

confidence: 99%