Background Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs . Objective This review aimed at identifying variables associated with frequent ED use by older adults. Methods For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence . A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. Conclusion Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty. Electronic supplementary material The online version of this article (10.1186/s12877-019-1197-9) contains supplementary material, which is available to authorized users.

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Objective: Only 12% of the Canadian older adults have adequate health literacy (HL) to understand and handle health information sufficiently. A descriptive correlation study was conducted to describe HL and to examine its relationship with healthcare services use among community-dwelling older adults living with chronic conditions in a distant region of Quebec, Canada.Methods: Data was collected through self-report instruments including the Health Literacy Questionnaire (HLQ), which assesses HL on nine dimensions.Results: Based on health characteristics of the nine HLQ dimensions, the results showed significant differences between subgroups of participants as well as a negative association between the HLQ dimension Appraisal of Health Information and the number of consultations with healthcare professionals (incidence rate ratio: 0.66; p = .027).Conclusions: The results highlight the need to improve older adults HL, in order to improve their health status and use of healthcare services.

The contexts of vulnerability are diversified and cover a wide range of situations where pregnant women are likely to experience threats or disparities. Nurses should consider the particular circumstances of women in contexts of vulnerability. We used a qualitative thematic synthesis to describe the experience of these women regarding their prenatal primary nursing care. We identified that the women's experience is shaped by the prenatal care. The fulfillment of their needs and expectations will guide their decision regarding the utilization of their prenatal care. We propose a theoretical model to guide nurses, promoting person-centered delivery of prenatal care.