Injury Hospitalization as a Marker for Emergency Medical Services Use in Elderly Patients

Abstract

The elderly utilize emergency medical services (EMS) at a higher rate than younger patients, yet little is known about the influence of injury on subsequent EMS utilization and costs.Objective-To assess injury hospitalization as a potential marker for subsequent EMS utilization and costs by Medicare patients.Methods-This observational study analyzed a retrospective cohort of all Medicare patients (≥67 years) with an ICD-9 injury diagnosis admitted to 125 Oregon and Washington hospitals during 2001-2002 who survived to hospital discharge. The number of EMS transports and total EMS costs were compared one year before and for one year following the index hospitalization.Results-There were 30,655 injured elders in our cohort. Their mean ICD-9 based injury severity score was 0.97, with 4.1% meeting a definition of severe injury and 37% having hip fractures. The mean (range) number of EMS transports before and after the injury was 0.5 (0-45) and 0.9 (0-56), for an unadjusted incidence rate ratio (IRR) of 1.7 (95% CI 1.7-1.8). The increase in EMS utilization following an injury hospitalization was even greater after adjusting for risk period and other model predictors (IRR 2.4, 95% CI 2.3-2.5). Annual EMS costs rose 74% following the injury hospitalization from $211 to $367 mean dollars per person. The greatest increase was in non-emergent EMS use, accounting for 67% of the increase in the number of uses. Institutionalization in a skilled nursing or rehabilitation facility either before or after injury was strongly associated with the need for EMS care.Conclusion-An injury hospitalization in the elderly serves as a sentinel marker for an abrupt increase in EMS utilization and costs, even after accounting for confounders. This supports systems planning, research and programs to prevent injuries in elders and alternative, costeffective modes of transport to accommodate this need.

Functional Decline Predicts Emergency Department Use in Veterans With Dementia

“…This is consistent with the findings of other studies showing functional status to be a predictor of health care utilization in general—both in the general elderly population 22 –26 and in specific diseases such as Parkinson’s 26 and stroke 27 —as well as elderly patients’ use of the ER. 3,28–38…”

“…Possible reasons why functional dependence is such a strong predictor is that it may reflect a frailty that predisposes an individual to become injured 31 or to fall, 32 which is the most common reason for an elder to use the ER. 4,33,34 Several studies also found that older adults commonly report that a decline in ADLs directly contributes to an ER visit.…”