Characteristics and outcomes of injury-related ED visits among older adults
ABSTRACT The objectives of this study were to examine the epidemiology of injury among older adults treated in emergency departments (EDs) and to explore the effect of advanced age and nursing home residence on associated outcomes.
A secondary data analysis of a nationally representative sample from the National Hospital Ambulatory Care Survey was conducted using available sampling weights and data from the US Census Bureau. Weighted multivariate logistic regression was used to explore factors associated with injury outcomes, including hospitalization and receipt of potentially inappropriate medications.
Nearly 21 million injury-related ED patient visits were made by older adults during the study period. Nearly 10% of episodes were identified as adverse events, which increased hospitalization risk 3-fold. Potentially inappropriate medications were provided during nearly 12% of encounters.
Injury reductions among elders could be achieved by reducing adverse events, whereas quality could be improved by reducing potentially inappropriate medication use in the ED.
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ABSTRACT: Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These individuals typically do not meet criteria for hospital admission, but because of limited reimbursement for observation, admitting physicians are often reluctant to accept these individuals for observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in-home care is also often difficult or impossible. As a result, older adults with nonoperative injuries often spend a long time in the ED waiting for an appropriate disposition. The challenges of identifying an appropriate disposition for these individuals, the consequences for patients, and some potential solutions to this commonly encountered problem are described.Journal of the American Geriatrics Society 03/2014; DOI:10.1111/jgs.12699 · 4.22 Impact Factor