Utilization of the Accident &amp; Emergency Departments by Chinese elderly in Hong Kong

Yip, Wai Lam; Fan, Kit Ling; Lui, Chun Tat; Leung, Louis M L; Ng, FH; Tsui, Kwok Leung

doi:10.5847/wjem.j.1920-8642.2015.04.006

“…The predominance of circulatory clinical assessments in both age groups, provides further support for this finding, implying a future substantial impact on the EMS. Respiratory as well as trauma and nonspecific clinical assessments are reported as being distinctive to older adults worldwide [ 5 , 18 , 49 , 50 ]. In the present study, psychiatric assessments were highly associated with the adult age group.…”

Section: Discussionmentioning

confidence: 99%

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

Hjalmarsson

¹

,

Holmberg

²

,

Asp

³

et al. 2020

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Background Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18–69 years requiring emergency care at home in Sweden. Methods A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. Results Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00–11:59 interval (p < 0.001, χ2 = 1224.08). Conclusion The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.

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“…[11,12] Elderly FAs contribute disproportionately, to both the total number of elderly patient visits to the ED and the ED resources utilized. [13,14] Compared to the elderly non-FAs, they are associated with increased utilization of ambulances and have higher rates of admission rates from the ED. However, in our study population, despite having a higher triage acuity and proportion of patients aged 85 years and older, elderly FAs do not have increased time to disposition at ED or increased inpatient length of stay.…”

Section: Discussionmentioning

confidence: 99%

Association between the elderly frequent attender to the emergency department and 30-day mortality: A retrospective study over 10 years

Shen¹,

Tay²,

Teo³

et al. 2018

World Journal of Emergency Medicine

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“…[11,12] Elderly FAs contribute disproportionately, to both the total number of elderly patient visits to the ED and the ED resources utilized. [13,14] Compared to the elderly non-FAs, they are associated with increased utilization of ambulances and have higher rates of admission rates from the ED. However, in our study population, despite having a higher triage acuity and proportion of patients aged 85 years and older, elderly FAs do not have increased time to disposition at ED or increased inpatient length of stay.…”

Section: Discussionmentioning

confidence: 99%

240 Association Between the Elderly Frequent Attender to the Emergency Department and 30-Day Mortality: A Retrospective Study Over 10 Years

Shen¹,

Tay²,

Teo³

et al. 2017

Annals of Emergency Medicine

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BACKGROUND:To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality. METHODS:Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student t-test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender.RESULTS: 1.381 million attendance records were analyzed. Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking at 10.2% in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year.CONCLUSION: Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.

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Utilization of the Accident & Emergency Departments by Chinese elderly in Hong Kong

Cited by 9 publications

References 8 publications

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

Association between the elderly frequent attender to the emergency department and 30-day mortality: A retrospective study over 10 years

240 Association Between the Elderly Frequent Attender to the Emergency Department and 30-Day Mortality: A Retrospective Study Over 10 Years

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