Review: Emergency Department Use by Older Adults: A Literature Review on Trends, Appropriateness, and Consequences of Unmet Health Care Needs

Women's College Hospital, Toronto, Ontario, Canada,
Medical Care Research and Review (Impact Factor: 2.57). 04/2011; 68(2):131-55. DOI: 10.1177/1077558710379422
Source: PubMed

ABSTRACT Older adults use emergency departments (EDs) more than any other age group and are more prone to subsequent adverse events. This article reviews the literature on ED use by older adults within the context of evaluating their need for emergency care and the extent to which access to primary and supportive care services affect use. While a substantial research literature describes general patterns of ED use, there is much less research on ED use as a function of other health service use. Gaps in the research literature result in a limited understanding of the full scope of the issue and opportunities for practice and policy intervention.

Download full-text


Available from: Andrea Gruneir, Aug 28, 2014
1 Follower
  • Source
  • Source
    Annals of Emergency Medicine 09/2010; 56(3). DOI:10.1016/j.annemergmed.2010.06.321
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To characterize emergency department (ED) use by nursing home residents in the United States. Analysis of the National Hospital Ambulatory Medical Care Survey. U.S. EDs from 2005 to 2008. Individuals visiting U.S. EDs stratified according to nursing home residency. All ED visits by nursing home residents were identified. The demographic and clinical characteristics and ED resource utilization, length of stay, and outcomes of nursing home residents and nonresidents were compared. During 2005 to 2008, nursing home residents accounted for 9,104,735 of 475,077,828 U.S. ED visits (1.9%; 95% confidence interval (CI) = 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were older (mean age 76.7, 95% CI = 75.8-77.5), female (63.3%), and non-Hispanic white (74.8%). Nursing home residents were more likely to have been discharged from the hospital in the prior 7 days (adjusted odds ratio (aOR = 1.4, 95% CI = 1.1-1.9), to present with fever (aOR = 1.9, 95% CI = 1.5-2.4) or hypotension (systolic blood pressure ≤90 mmHg, aOR = 1.8, 95% CI = 1.5-2.2), and to receive diagnostic tests (OR = 1.9, 95% CI = 1.6-2.2), imaging (OR = 1.5, 95% CI = 1.3-1.7), or procedures (OR = 1.6, 95% CI = 1.4-1.7) in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Nursing home residents were more likely to be admitted to the hospital (aOR = 1.8, 95% CI = 1.6-2.0) and to die (aOR = 2.3, 95% CI = 1.6-3.3). Nursing home residents account for more than 2.2 million ED visits annually in the United States. Nursing home residents have greater medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the United States.
    Journal of the American Geriatrics Society 10/2011; 59(10):1864-72. DOI:10.1111/j.1532-5415.2011.03587.x
Show more