Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

Abstract

Background Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18–69 years requiring emergency care at home in Sweden. Methods A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. Results Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00–11:59 interval (p < 0.001, χ2 = 1224.08). Conclusion The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.

Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia

“…The logistic model for both crude data and after adjustment showed that EMS missions for elderly patients were significantly less likely to be associated with the odds of NC due to PIR. This significant association between elderly patients and the low rate of NC due to PIR is consistent with several studies showing the high association between elderly and the transportation by ambulances to EDs [36][37][38][39][40]. Oosterwold J et al, in their systematic review, found that the severity of the medical condition for elderly patients was not the main predictor of conveyance, but there were different factors related to EMS structure and related to the patients themselves [41].…”

Ambulance clinicians’ attitudes to older patients’ self‐determination when the patient has impaired decision‐making ability: A Delphi study

“…A significant contributor to this increase is the growing population of older people with greater healthcare needs. This is confirmed by a recent study indicating a considerable increase in dispatched ambulance resources for patients between 70 and 89 years of age, showing that 60% of the assignments involved older patients >70 years of age (Hjalmarsson et al, 2020). Because autonomy is an important ethical value for most patients, it is also important to understand how ambulance clinicians (ACs) perceive and manage patient autonomy.…”

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

“…There is an ongoing global discussion to meet the need of an ageing population by increasing collaboration between healthcare organizations in out-of-hospital settings (NHS, 2019 ; SOU 2020 :19, 2020), such as between ambulance service and primary healthcare (PHC) centres (NHS, 2019 ). The need for ambulance care increases with age (Jones et al, 2017 ), and around 40–60% of patients engaging ambulance services are 65 years or older (Duong et al, 2018 ; Hjalmarsson et al, 2020 ). There is an upward trend for older patients to receive their entire care in out-of-hospital settings, such as in their own home or at PHC centres after calling for an ambulance (Forsgärde et al, 2020 ; Hjalmarsson et al, 2020 ).…”

“…The need for ambulance care increases with age (Jones et al, 2017 ), and around 40–60% of patients engaging ambulance services are 65 years or older (Duong et al, 2018 ; Hjalmarsson et al, 2020 ). There is an upward trend for older patients to receive their entire care in out-of-hospital settings, such as in their own home or at PHC centres after calling for an ambulance (Forsgärde et al, 2020 ; Hjalmarsson et al, 2020 ). Not being transported by an ambulance to the emergency department (ED) is also known as non-conveyance to hospitals.…”