Characteristics of frequent geriatric users of an urban emergency department

Abstract

Background: As the population ages, it is projected that older adults will increase emergency department (ED) utilization and contribute to ED crowding. Older patients are at risk of decreased health-related quality of life after an ED visit. Characteristics of older adults that frequently use the ED have not been well studied, and prior studies have shown that lack of access to primary care may influence ED utilization.

Objective: Determine factors associated with frequent Emergency Department (ED) utilization by older adults.

Methods: Retrospective chart review of all patients ≥ 65 years of age seen in an urban ED between December 2007 and September 2008. A prospective telephone survey was done of "frequent" (≥ 4 ED visits over a 6-month period) geriatric users. "Frequent" and "infrequent" geriatric ED users were compared using chi-squared and t-test. Survey results are univariate descriptive statistics.

Results: There were 8520 ED visits of adults ≥ 65 years of age analyzed, of which 5718 were unique patients. Of these, 268 (5%) were frequent ED users. Frequent geriatric ED users were more likely to be Black or Hispanic and were considered less urgent at triage. Of the 59 surveyed frequent users of the ED, 95% reported having a usual source of care, though only 36% contacted their outpatient provider before a visit to the ED.

Conclusion: Frequent geriatric users of the ED were considered less urgent at triage, and although most identified themselves as having a primary care provider in the community, many did not contact them before going to the ED.