Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
Highlights
As a result of the growing aging population, there has been an increase in the prevalence of chronic medical conditions (CMCs)
We found that 27% and 14% of older AAs in Service Planning Area 6 (SPA6), one of the most economically disadvantaged areas in South Los Angeles, had at least one or two emergency department (ED) visits within a one-year period
The results of the current study suggest avenues for future research on ED utilization patterns of low income urban older AAs with multiple CMCs
Summary
As a result of the growing aging population, there has been an increase in the prevalence of chronic medical conditions (CMCs). In lieu of system-level difficulties in managing the chronic conditions of this population, the emergency department (ED) has taken on a significant role in providing care for this population [1]. Based on the current rate of growth in healthcare utilization, by 2050 it is expected that the US health system would not be able to meet the demands of the older population who would need. ED utilization in populations with CMCs. Emergency Departments deliver important healthcare services and commonly serve as the point of entry to the hospital system or as a means of connecting patients to after-hours care, those without a primary care provider (PCP). While EDs will always play a vital role, ED over-utilization remains a concern and could be reduced through better downstream management of chronic conditions. Further investigation of the health status of older adults who utilize the ED is warranted and may yield insight into the factors that contribute to ED utilization and hospitalization [4]
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