Repeat Visits Among Elders In An Urban Emergency Setting

Abstract

Objectives: This pilot project seeks to understand recidivism rates among urban elderly in an academic emergency department (ED). Secondary goals include analysis of specialty versus primary medical care among frequent users of emergency services, as well as the effect of geriatric medicine on ED recidivism. Methods: A convenience sample of elderly patients 60 years old and older completed a brief survey designed to identify primary hospital and clinic affiliations, number of ED visits within a month, and any previous geriatric assessments. Results: Forty-eight patients participated: African Americans (50%), Caucasian (23%), Latinos (21%), and Other (6%). Approximately 79% of ED elders reported established links to institution. Only 35% of these elders identified a primary care clinic. 35% of elders surveyed indicated 2 or more ED visits within a 30-day period. 85% indicated no formal geriatric assessment or interdisciplinary geriatric team care. Conclusion: This study suggests that ED recidivism rates among elders may be both health care system and patient issues. System problems contributing to high ED usage appear to be due to high specialty care and absence of coordinate geriatric care. Patient problems associated with ED recidivism may be linked to inability to identify a primary care provider. These data underscore the need for novel interventions on behalf of high risk elderly to decrease ED recidivism rates. Creating health systems with better collaborations are likely to benefit elderly by decreasing their reliance on emergency services.