Disability is associated with emergency room visits in the elderly: a population-based study.

Abstract

Emergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing. The aim of the present study was to assess whether among older subjects functional disability is associated with increased ER visits and hospitalization rates. We assessed the association of functional ability with 1-year ER visits and hospitalization rates in all 342 subjects aged 75+ living in Tuscania (Italy) in 2004. Functional ability was estimated using the Katz' activities of daily living (ADLs), and the Lawton and Brody scale for the instrumental activities of daily living (IADLs). Functional disability was defined as the dependence for two or more ADLs or IADLs. According to Cox regression, disability in ADLs was associated with increased risk of ER visits (RR 2.12; 95% CI 1.11-4.08; P=.023) but not of hospital admission (RR 1.50; 95% CI .80-2.80; P=.208). Also, in Poisson regression, ADLs disability predicted the number of ER visits (IRR 2.56; 95% CI 1.48-4.40; P=.001). Disability is associated with increased risk of ER visits, but not of subsequent hospitalization in community-dwelling elderly, independent of clinical conditions. Dedicated studies are needed to evaluate the impact of social interventions for disabled elderly on ER access rates. Emergency Departments should implement innovative triage procedures to identify older patients with disability who gain access to ER, to recognize and classify any unmet social needs.