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. 2012 Jun;31(6):1277-85.
doi: 10.1377/hlthaff.2011.0922.

Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there

Alexander K Smith  1 , Ellen McCarthy, Ellen Weber, Irena Stijacic Cenzer, John Boscardin, Jonathan Fisher, Kenneth Covinsky
Affiliations

Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there

Alexander K Smith et al. Health Aff (Millwood). 2012 Jun.

Erratum in

  • Health Aff (Millwood). 2012 Jul;31(7):1650

Abstract

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

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Figures

Exhibit 2
Exhibit 2
Cumulative Incidence of emergency department (ED) visits during the last 6 months of life, noting the incidence on the last day of life (9%), and the cumulative incidence at 30 days before death (51%) and 180 days before death (75%).
Exhibit 3
Exhibit 3
Flow diagram outlining emergency department, hospitalization, and location of death among the 4,58 patients in the Health and Retirement Study (HRS) who died between 1992 and 2006. Early hospice use indicates hospice use prior to the last month of life. Discrepancies between hospitalization and location of death may be explained by direct admissions to the hospital and differential sources of information for these factors. Sources of data are: * HRS and National Death Index mortality files; † Medicare claims data; ‡ HRS interviews with next-of-kin following subject’s death. Abbreviation: ED – emergency department.
Appendix 1
Appendix 1
Time trends in emergency department (ED) use in the last month of life 1994 to 2006 are displayed. Sample sizes of decedents were too small in 1992 and 1993 to generate reliable estimates. Panel A: Time trends in ED use adjusted for age at death. Panel B: time trends adjusted for age at death and rising rates of early hospice use (hospice use before the last month of life) over the examined time period (1994, 5%; 2006, 15%).
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References

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