Emergency hospital admissions among older adults living alone in the community

Abstract

Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.

System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana

“…Considerable literature has emerged describing demographic, biological, and socioeconomic factors that contribute to health services uptake among older adults [ 11 , 17 ]. Older adults with better economic conditions tend to access and utilize health services easily and more desirably [ 17 , 18 ]. This evidence suggests existential barriers to access and use of health services needed by older people with lower socioeconomic status.…”

Validation of a Simple Score for Mortality Prediction in a Cohort of Unselected Emergency Patients

“…Physician-specific factors include patient load at presentation time [ 35 ]—increasing number of patients also increasing admission, risk preference [ 36 , 37 ]—admission is more likely the more risk-adverse the physician is, and individual experience [ 32 ]. Patient-specific factors include living situation (e.g., children at home) [ 38 , 39 ], substance abuse [ 40 ]—patients are less likely to agree to admission, and established and well managed out-patient care or simply the patients [ 41 ] or proxies' preference [ 42 ]. Institutional factors include hospital capacity and inadequate out-patient care [ 34 ], necessitating inpatient care.…”

A mixed‐methods systematic review of nurse‐led interventions for people with multimorbidity

“…Isolation compounds this risk, as older people with multimorbidity who live alone are more likely to require emergency care than those who live with others (Barrenetxea et al, 2021). The structure of healthcare services also places people with multimorbidity at risk of care fragmentation and treatment burden (Morris et al, 2021).…”

“…The cumulative burden of disease alongside socioeconomic drivers of poor health mean that those with multimorbidity are at increased risk of mortality, disability, functional decline, increased healthcare use and reduced quality of life (Xu et al, 2017 ). Isolation compounds this risk, as older people with multimorbidity who live alone are more likely to require emergency care than those who live with others (Barrenetxea et al, 2021 ). The structure of healthcare services also places people with multimorbidity at risk of care fragmentation and treatment burden (Morris et al, 2021 ).…”