Abstract
BackgroundDespite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable.ObjectiveTo identify socio-demographic characteristics and health care resources use of older adults admitted to emergency department for a potentially preventable visit.DesignData come from the Multipurpose Survey “Health conditions and use of health services”, edition 2012–2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households.Subject50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered.MethodsPotentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed.ResultsIn the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75–84 years: OR 1.096, CI 1.001–1.199; 85+years: OR 1.022, CI 1.071–1.391), at least one hospital admission (OR 3.869, IC 3.547–4.221), to waive a visit (OR 1.188, CI 1.017–1.389) or an exam (OR 1.300, CI 1.077–1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819–0.975), area of residence (Center: OR 0.850; CI 0.766–0.943; Islands: OR 0.617, CI 0.539–0.706, South: OR 0.560; CI 0.505–0.622), private paid assistance (OR 0.761, CI 0.602–0.962); a better health-related quality of life (PCS score 46–54: OR 0.744, CI 0.659–0.841; PCS score >55: OR 0.746, CI 0.644–0.865).ConclusionsOur study identified several characteristics associated with an increased risk of potentially preventable visits to the emergency department. This might allow the development of specific interventions to prevent the access of at risk subjects to the emergency department.
Highlights
Older patients represent between 12% and 21% of the emergency department (ED) visits and this percentage is expected to increase in the coming decades [1], growing up to about 34% by 2030 [2]
Preventable visits were defined as an emergency department visit that did not result in inpatient admission
Factors associated with an increased risk of a potentially preventable visit were older age (75–84 years: OR 1.096, CI 1.001–1.199; 85+years: OR 1.022, CI 1.071– 1.391), at least one hospital admission, to waive a visit or an exam
Summary
Over 20% of ED attendances are potentially preventable [6], with an increased risk of adverse consequences such as re-admission, hospitalization, mortality [7]. Several studies focused on the potentially preventable ED visit patterns by older adults, but only a few are population-based [5], and many studies are based on administrative data. The hospital administrative data provided a very limited insight other than medical diagnoses, considering that older people attend the ED for a range of reasons that are individual, societal and related to the health services system, as well as strictly clinical [8]. Despite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable
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