ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

Abstract

Background The rise in emergency department (ED) utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to positively impact the care of older adults. Symptoms have been associated with ED utilization, however, it remains unclear if symptoms are the primary reason for ED utilization. Purpose Describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department. Examine the differences in self-reported symptoms among those who utilized the emergency department, and those who did not. Procedures A prospective longitudinal design was used. The sample included 403 community-dwelling older adults 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. Main Findings Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance, and fair/poor well-being were significantly associated with ED utilization. Conclusions Several symptoms were common among this cohort of older adults. However, there were no significant differences in the types of symptoms reported by older adults who utilized the emergency department compared to those who did not use the emergency department. Based on these findings, symptoms among community-dwelling older adults may not be the primary reason for ED utilization.

Who Doesn’t Come Home? Factors Influencing Mortality Among Long-Term Care Residents Transitioning to and From Emergency Departments in Two Canadian Cities

“…Despite family involvement not directly influencing death, family involvement was included in this model because research supports that families are often not effectively prepared for end-of-life processes, and family involvement in decisions to transfer have been linked to avoidable transitions (Tate et al, 2020;Trahan et al, 2016). Other studies show resident ED utilization may be more likely upon family request, or when older persons perceive they have low levels of social support (Barken et al, 2016;Dermody et al, 2017;Tate et al, 2020;Trahan et al, 2016). Including this variable in the model provides a preliminary framework for adding other factors related to the interactions between families and health care professionals involved in transition decisions, and advance care planning.…”