Risk factors for frequent emergency department visits of veterans home residents in Northern Taiwan

Abstract

a b s t r a c tPurpose: The purpose of this study was to evaluate risk factors for frequent emergency department (ED) visits among older Chinese men living in a veterans home in northern Taiwan Methods: In 2006, all residents of Banciao Veterans Home were invited for study. Minimum Data Set Nursing Home 2.1 Chinese version, Chinese version of Geriatric Depression Scale (GDS) short form, minimental status examinations (MMSE), and Charlson Comorbidity Index (CCI) were used for study. ED records of all study participants were obtained from Taipei Veterans General Hospital, and frequent ED visitors were defined as who visited ED for three times or more in 1 year. Results: Overall, 609 residents (mean age ¼ 80.9 AE 5.3 years, all men) were enrolled, and 169 (27.8%) of them visited the ED for at least once. Among all participants, 30 (4.9%) were frequent ED visitors. Frequent ED visitors were significantly older, disabled, cognitively impaired, depressed, urinary incontinent, having poorer social engagement score, and higher Charlson's comorbidity index (CCI). Adjustments for age, activities of daily living, depression, cognitive impairment (adjusted odds ratio: 3.19; 95% confidence interval: 1.37e7.46, p ¼ 0.004) and higher CCI (adjusted odds ratio: 1.69; 95% confidence interval: 1.20e2.39, p ¼ 0.003) were independent risk factors for frequent ED visits. Conclusion: The cumulative incidence of ED visit was 51 visits per 100 person-years, and the prevalence of frequent ED visitors was 4.9% among older veterans living in a Veterans Home. Cognitive impairment and higher Charlson's comorbidity index were independent risk factors for frequent ED visitors. Further study is needed to explore the unmet health-care needs for frequent ED visitors in the veterans home.

Predicting clinical instability of older patients in post‐acute care units: A nationwide cohort study

“…It has been reported that depressive symptoms as a result of acute or chronic conditions might be improved by PAC services due to increased social interactions between patients, clinical staff and caregivers, which might explain the lack of association between GDS score and acute ward readmissions in the present study. Although acute hospitalizations and critical care can jeopardize cognitive function in older patients, the associations between the cognitive decline and acute ward readmissions remains controversial . Nevertheless, low MMSE score at PAC unit admission was the only predictive factor of medical ward readmissions in the present study.…”

“…Although acute hospitalizations and critical care can jeopardize cognitive function in older patients, 39 the associations between the cognitive decline and acute ward readmissions remains controversial. [40][41][42] Nevertheless, low MMSE score at PAC unit admission was the only predictive factor of medical ward readmissions in the present study. Among all patients readmitted to acute wards, the vast majority were due to acute medical conditions, but surgical conditions all occurred in late readmissions.…”

Predictors of transport to hospital after emergency ambulance call‐out for older people living in residential aged care

“…17 The increased transport rates for people with multiple chronic diseases and people with chronic cardiac conditions are consistent with studies from in-hospital settings where these are associated with increased risk of ED presentation. 4,18,19 Additionally, across inpatient settings, chronic mental illness has also been associated with increased rate of emergency health system use and supports the higher rate of transport for patients with a diagnosis of depression. 20 Studies from hospital settings have produced varying results regarding the impact of cognitive impairment and dementia on presentation to hospital, with some reporting increased and some reporting decreased presentation rates in these groups.…”

“…20 Studies from hospital settings have produced varying results regarding the impact of cognitive impairment and dementia on presentation to hospital, with some reporting increased and some reporting decreased presentation rates in these groups. 4,[18][19][20][21] This variation may reflect unmeasured differences in resources of RACs such as specialist dementia care units, availability of outreach and community care services and prevalence of advance care directives between different study settings. 4 In our study, there was no significant association between dementia and odds of transport to hospital.…”

Association of cognitive impairment, depressive symptoms and sarcopenia among healthy older men in the veterans retirement community in southern Taiwan: A cross‐sectional study

“…All residents living in the Gangshan Veterans Home, a veterans retirement community in southern Taiwan, were invited to participate in the study and were screened for study enrolment if informed consent was obtained. Of the 389 residents being screened, one woman and 11 people aged younger than 65 years were excluded from the study.…”