Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

Abstract

IntroductionThe elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”.Material and MethodsA retrospective study was performed during the calendar year 2014 (1st January 2014 – 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.ResultsA total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2).DiscussionOlder patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.ConclusionEnhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly.

Community paramedics treat high acuity conditions in the home: a prospective observational study

“…5 Once in the ED, due to medical complexity, frailty and uncertain availability of ambulatory follow-up, older adults experiencing a change in condition are highly likely to be admitted. [19][20][21][22][23] Moreover, both medical and legal concerns on the part of ED providers and current CMS financial incentives favour hospital admission even for patients at the end of life despite the considerable literature supporting the potential for iatrogenic injury and high cost of hospital utilisation and post-acute care at the end of life. 24 25 Indeed, in addition to associated decline in cognitive and functional status, hospitalisation of frail chronically ill individuals significantly increases the probability of post-hospital nursing home care placement.…”

Physical Fitness in Hospitalized Frail Elderly Patients

“…These patients are stable during certain periods, but they may gradually or suddenly experience an exacerbation and acute hospital care may be necessary 61,62 . Frail elderly individuals with multimorbidity and disability are frequent visitors to acute medical hospital departments 63 . In this group of patients, admissions are often inevitable, they often require a longer length of stay compared with their younger counterparts and the re-admission rate is high [64][65][66] .…”

Frequent emergency department use by older adults with ambulatory care sensitive conditions: A population‐based cohort study

“…Approximately 6% of older adults are considered frequent users of emergency departments (ED), accounting for up to 30% of such use. 1 Frequent geriatric users are defined as patients aged >65 years with numerous ED visits within a year-long period, the most accepted definition being four or more visits. 1 ED visits put older adults at risk of adverse effects, including hospitalization, frequent ED episodes, functional decline, and complications regarding treatments and procedures.…”

“…1 Frequent geriatric users are defined as patients aged >65 years with numerous ED visits within a year-long period, the most accepted definition being four or more visits. 1 ED visits put older adults at risk of adverse effects, including hospitalization, frequent ED episodes, functional decline, and complications regarding treatments and procedures. 2 The high use of ED by older adults also has implications for healthcare systems, some of which are already burdened with overcrowding.…”