The role of health and non-health-related factors in repeat emergency department visits in an elderly urban population

TY - JOUR

T1 - The role of health and non-health-related factors in repeat emergency department visits in an elderly urban population

AU - Naughton, Corina

AU - Drennan, Jonathan

AU - Treacy, Pearl

AU - Fealy, Gerard

AU - Kilkenny, Margaret

AU - Johnson, Felicity

AU - Butler, Michelle

PY - 2010/9

Y1 - 2010/9

N2 - Introduction: Patients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED attendance, defined as one or more visits in the previous 6 months in patients aged 65 years or older, and to examine the interaction between social and health factors. Methods: 306 patients were interviewed. Demographic, socioeconomic, physical, mental health and post-ED referrals were examined. Logistic regression was used to identify factors independently associated with a repeat ED visit, OR and 95% CI are presented. Log likelihood ratio tests were used to test for interactions. Results: ED revisits were reported by 37% of this elderly population. Independent risk factors for a repeat ED visit were previous hospital admission OR 3.78 (95% CI 2.53 to 5.65), anxiety OR 1.13 (95% CI 1.04 to 1.22), being part of a vulnerable social network OR 2.32 (95% CI 1.12 to 4.81), whereas a unit increase in physical inability as measured by the Nottingham Health Profile had a week association OR 1.01 (95% CI 1.00 to 1.02). There were no significant interactions between social networks and the other health-related variables (p>0.05). In patients directly discharged from ED, 48% (71/148) had no documented referrals made to community services, of which 18% (27/148) were repeat ED attendees. Conclusion: ED act as an important safety net for older people regardless of economic or demographic backgrounds. Appropriate assessment and referral are an essential part of this safety role.

AB - Introduction: Patients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED attendance, defined as one or more visits in the previous 6 months in patients aged 65 years or older, and to examine the interaction between social and health factors. Methods: 306 patients were interviewed. Demographic, socioeconomic, physical, mental health and post-ED referrals were examined. Logistic regression was used to identify factors independently associated with a repeat ED visit, OR and 95% CI are presented. Log likelihood ratio tests were used to test for interactions. Results: ED revisits were reported by 37% of this elderly population. Independent risk factors for a repeat ED visit were previous hospital admission OR 3.78 (95% CI 2.53 to 5.65), anxiety OR 1.13 (95% CI 1.04 to 1.22), being part of a vulnerable social network OR 2.32 (95% CI 1.12 to 4.81), whereas a unit increase in physical inability as measured by the Nottingham Health Profile had a week association OR 1.01 (95% CI 1.00 to 1.02). There were no significant interactions between social networks and the other health-related variables (p>0.05). In patients directly discharged from ED, 48% (71/148) had no documented referrals made to community services, of which 18% (27/148) were repeat ED attendees. Conclusion: ED act as an important safety net for older people regardless of economic or demographic backgrounds. Appropriate assessment and referral are an essential part of this safety role.

KW - Aged

KW - Aged, 80 and over

KW - Emergency Medical Services

KW - Female

KW - Health Services for the Aged

KW - Health Status Indicators

KW - Hospitals, Teaching

KW - Humans

KW - Ireland

KW - Logistic Models

KW - Male

KW - Patient Admission

KW - Patient Readmission

KW - Questionnaires

KW - Risk Factors

KW - Socioeconomic Factors

KW - Urban Population

U2 - 10.1136/emj.2009.077917

DO - 10.1136/emj.2009.077917

M3 - Article

C2 - 20581390

SN - 1472-0205

VL - 27

SP - 683

EP - 687

JO - EMERGENCY MEDICINE JOURNAL

JF - EMERGENCY MEDICINE JOURNAL

IS - 9

M1 - N/A

ER -