Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care

Abstract

To describe factors predicting frequent emergency department (ED) use among rural older adults receiving home care services in Ontario, Canada. A cross-sectional examination of Ontario hospital administrative data linked to provincial home care data compares frequent ED users (i.e. >4 visits/year) with regular users (i.e. 1-3 visits/year) and no ED use over a 1-year period. Multiple logistic regression analysis was performed using independent variables from home care health assessments. Predictors of frequent ED use among rural older adults receiving home care services using adjusted odds ratios (ORs) and 95% confidence intervals (CI). Ontario's rural home care clients visited the ED an average of 4.9 times (SD = 11.9) over a year. Frequent ED users were observed in 170 cases per 1000 home care clients. Congestive heart failure was the most frequently cited reason for frequent ED use; however, it was not a main driver in the adjusted model. Frequent ED use was predicted by younger age (i.e. 60-74 years) (OR = 1.9; 95% CI, 1.7-2.2), a recent ED visit in the last 3 months (OR = 1.5; 95% CI, 1.4-1.7), regularly taking >9 medications (OR = 1.5; 95% CI, 1.3-1.6), and poor self-rated health (OR = 1.4; 95% CI, 1.2-1.5). Despite popular assumptions, the main drivers for frequent ED use among rural older adults in Ontario included a mix of sociodemographic and clinical characteristics, rather than disease diagnoses.