Abstract
Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50–5.58); UTI (aOR: 4.44, 95% CI 3.97–4.98); sepsis (aOR: 3.54, 95% CI 3.06–4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63–3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.
Highlights
Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services
From 2002 to 2013, there was a consistent rise in the rate of overall emergency department (ED) visits in Taiwanese elderly population, and more than half of ED visits were made by male elderly (53.1%, 95% confidence interval (CI) 52.78 to 53.44) (Supplementary Fig. S1 and Table S1)
Temporal patterns are analogous for the two measures examining ambulatory care sensitive conditions (ACSCs)-specific ED visits, the degree of increase in the rate of visit seems slightly greater than that of the proportion of elderly with a visit
Summary
Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. We examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Higher rates of emergency department (ED) visits are typically observed in the elderly compared to other age groups[3,4] Common reasons for their ED visits include age-related chronic problems or fall-related injuries[5], but they frequently involve conditions triggered by infections such as pneumonia and urinary tract infections[6]. We seek to investigate if NH elderly are at increased risk of acquiring preventable ED visits due to ACSCs using population-wide data
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