Age and sex differences in emergency department visits of nursing home residents: a systematic review

Annika Brucksch,Katharina Allers,Falk Hoffmann

doi:10.1186/s12877-018-0848-6

Abstract

BackgroundNursing home residents (NHRs) are often transferred to emergency departments (EDs). A great proportion of ED visits is considered inappropriate. There is evidence that male NHRs are more often hospitalised, but this is less clear for ED visits. It is unclear, which influence age has on ED visits. We aimed to study the epidemiology of ED visits in NHRs focusing on age- and sex-specific differences.MethodsA systematic review was carried out based on articles found in MEDLINE (via PubMed), CINAHL and Scopus. Articles published on or before Aug 31, 2017 were eligible. Two reviewers independently identified articles for inclusion. The quality of studies was assessed by the Joanna Briggs Institute critical appraisal tool for prevalence studies.ResultsOut of 1192 references, we found seven studies meeting our inclusion criteria. Six studies were conducted in the USA or Canada. Overall, 29–62% of NHRs had at least one ED visit over the course of 1 year. Most studies assessing the influence of sex found that male residents visited EDs more frequently. All but one of the five studies with multivariable analyses reported a statistically significant positive association (with odds or rate ratios of 1.05–1.38). All studies assessed the influence of age. There was no clear pattern with some studies showing no association between ED visits and age and other studies reporting decreasing ED visits with increasing age or increasing proportions followed by a decrease in the highest age group. Studies used 85+ or 86+ years as the highest age category. Hospital admission rate ranged from 36.4 to 48.7%. There was no study reporting stratified analyses by age and sex. Only one study reported main diagnoses leading to ED visits stratified by sex.ConclusionMale NHRs visit EDs more often than females, but there is no evidence on reasons. The association with age is unclear. Any future study on acute care of NHRs should assess the influence of age and sex. These studies should include large sample sizes to provide a more differentiated age categorisation.Trial registrationPROSPERO CRD42017074845.

Highlights

Nursing home residents (NHRs) are often transferred to emergency departments (EDs)
Full text screening resulted in the exclusion of 90 articles and a total of seven articles were eligible for inclusion
The influence of age was less clear with some studies showing no association and others reporting decreasing ED visits with increasing age or increasing proportions followed by a decrease in the highest age group

Summary

Introduction

Nursing home residents (NHRs) are often transferred to emergency departments (EDs). There is evidence that male NHRs are more often hospitalised, but this is less clear for ED visits It is unclear, which influence age has on ED visits. A large proportion of these ED presentations is considered inappropriate [4, 5] It is questionable if benefits outweigh potential risks as ED visits of NHRs often result in unintended consequences and adverse outcomes like greater cognitive and physical decline or hospital-acquired infections [6, 7]. 50% of NHRs visiting EDs are discharged back to the nursing home without being hospitalised [8, 9] and almost one fifth of presentations followed by ED discharge had no diagnostic testing at all [9]

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