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: 2.62). 04/2011; 68(2):131-55. DOI: 10.1177/1077558710379422
Source: PubMed


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.

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Available from: Andrea Gruneir, Aug 28, 2014
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    • "Transfers of frail nursing home (NH) residents to and from the emergency department (ED) are common and costly and expose vulnerable residents to the well-documented risks associated with care transitions [1] [2] [3] [4] [5] [6] [7]. Despite increasing legislation to monitor and enforce NH standards and quality of care over the past decade, the number of ED visits by NH residents has increased 12.8%, from 1.9 million to 2.1 million visits, and there has been no significant change in rates of potentially preventable ED visits [8]. "
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    ABSTRACT: Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups ( n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.
    Full-text · Article · Sep 2015 · Current Gerontology and Geriatrics Research
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    • "The increasing pressure on emergency departments and recognition of their role in end-of-life care highlight the dearth of community based services and failure of advance care planning [90-92]. Commonly, emergency presentations result from inadequate symptom control in the community and/or absence of adequate care givers [93-95]. "
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    ABSTRACT: Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia. A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006). Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time. Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia's health system.
    Full-text · Article · Mar 2014 · BMC Health Services Research
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    • "Similarly, this study provides original information on the chronologic trends in ED length of stay. Previous studies described longer ED stays for patients 65+ y when compared to younger patients [6,17-19]. The current study adds to these observations in showing that both age groups were significantly affected over time, but in opposite directions: while ED length of stay shortened in younger patients from 2005 to 2010, it lengthened in older ones. "
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    ABSTRACT: Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65--84 years during this period and to investigate the evolution of these comparisons over time. Data considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated. Between 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65--84 years. Compared to patients aged 65--84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010. Oldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.
    Full-text · Article · Sep 2013 · BMC Health Services Research
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