The ‘unnecessary’ use of emergency departments by older people: findings from hospital data, hospital staff and older people

Abstract

Objective. Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations.'Methods. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period.Results. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals.Conclusions. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.What is known about the topic? Increasing demands are being placed on hospital emergency departments and there are concerns that a growing number of presentations are 'inappropriate presentations'. Older people are considered to be one group that overuse emergency department services. What does this paper add? Most studies use hospital statistics to examine primary care presentations at emergency departments or present the viewpoints of medical staff within hospitals about the necessity of these visits. This paper compares and contrasts the available data from hospitals, the opinions of medical and allied health professionals and information collected from older people themselves to provide greater insight into why older people triaged as three, four or five attend emergency departments in Adelaide. What are the implications for practitioners? For a range of reasons including availability of quality care, familiarity with hospital services, and a lack of community based services, older people will continue to present to emergency departments. With increasing numbers of older people in the population, hospital emergency departments will need to continuously adapt to accommodate the needs of this older demographic and for staff to acquire necessary geriatric skills.Additional...

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