Abstract
BackgroundNursing home (NH) residents are frequent users of emergency departments (ED) and while prior research suggests that repeat visits are common, there is little data describing this phenomenon. Our objectives were to describe repeat ED visits over one year, identify risk factors for repeat use, and characterize “frequent” ED visitors.MethodsUsing provincial administrative data from Ontario, Canada, we identified all NH residents 65 years or older who visited an ED at least once between January 1 and March 31, 2010 and then followed them for one year to capture all additional ED visits. Frequent ED visitors were defined as those who had 3 or more repeat ED visits. We used logistic regression to estimate risk factors for any repeat ED visit and for being a frequent visitor and Andersen-Gill regression to estimate risk factors for the rate of repeat ED visits.ResultsIn a cohort of 25,653 residents (mean age 84.5 (SD = 7.5) years, 68.2% female), 48.8% had at least one repeat ED visit. Residents who experienced a repeat ED visit were generally similar to others but they tended to be slightly younger, have a higher proportion male, and a higher proportion with minimal cognitive or physical impairment. Risk factors for a repeat ED visit included: being male (adjusted odds ratio 1.27, (95% confidence interval 1.19–1.36)), diagnoses such as diabetes (AOR 1.28 (1.19–1.37)) and congestive heart failure (1.26 (1.16–1.37)), while severe cognitive impairment (AOR 0.92 (0.84–0.99)) and 5 or more chronic conditions (AOR 0.82 (0.71–0.95)) appeared protective. Eleven percent of residents were identified as frequent ED visitors, and they were more often younger then 75 years, male, and less likely to have Alzheimer’s disease or other dementias than non-frequent visitors.ConclusionsRepeat ED visits were common among NH residents but a relatively small group accounted for the largest number of visits. Although there were few clear defining characteristics, our findings suggest that medically complex residents and younger residents without cognitive impairments are at risk for such outcomes.
Highlights
Nursing home (NH) residents are frequent users of emergency departments (ED) and while prior research suggests that repeat visits are common, there is little data describing this phenomenon
Emergency department visits We identified all unscheduled ED visits that occurred between the index ED visit and the end of the follow-up period
Fifty-four percent experienced moderate or severe cognitive impairment, and 85.0% experienced moderate to full Activities of Daily Living (ADL) dependence
Summary
Nursing home (NH) residents are frequent users of emergency departments (ED) and while prior research suggests that repeat visits are common, there is little data describing this phenomenon. In the general (non-NH) population, a small proportion of individuals (4–8%) accounts for a relatively large share of all ED visits [5, 6] This group of “frequent ED users” has been shown to be fairly heterogeneous but are more likely to experience poor physical and mental health, and problems with substance abuse than other ED users [7,8,9]. Among older adults in the general population, nearly 15% return to the ED within 30 days of an initial visit For this group, return to the ED is associated with cognitive impairment, multiple chronic conditions, depression, and a history of prior ED use [12]
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