Early revisit, hospitalization, or death among older persons discharged from the ED

Friedmann, Peter D.; Jin, Lei; Karrison, Theodore; Hayley, Déon Cox; Mulliken, Robert; Walter, James J.; Chin, Marshall H.

doi:10.1053/ajem.2001.21321

Cited by 129 publications

(83 citation statements)

References 25 publications

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“…[1][2][3] They have further been identified as a vulnerable population in the emergency department (ED) environment, having substantially inferior clinical outcomes after discharge from the ED, [4][5][6] with higher rates of missed diagnoses and medication errors compared with younger, severity-matched controls. [7][8][9] Internationally, presentations of older people to EDs are projected to increase markedly as a result of rapid population aging.…”

Section: Background and Rationalementioning

confidence: 99%

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change

Burkett

Martin‐Khan

Scott³

et al. 2017

Aust. Health Review

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Objectives. The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050.Methods. A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and 85 years) to 2050.Results. From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged 85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people.Conclusion. Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people.What is known about the topic? Rapid population aging is anticipated over coming decades. International studies and specific local-level Australian studies have demonstrated significant growth in ED presentations. There have been no prior national-level Australian studies of ED presentation trends by age group. What does this paper add? The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. ED presentation growth was found to exceed population growth in all age groups. The rate of ED presentations per head of population was highest among those aged 85 years. What are the implications for practitioners? Growth in ED presentations exceeding population growth suggests that current models of acute health care delivery require review to ensure that optimal care is delivered in the most fiscally efficient manner. Trends in presentation of older people emphasise the imperative for ED workforce planning and education in care of this complex patient cohort, and the requirement to review funding models to incentivise investment in ED avoidance and substitutive care models targeting older people.

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Section: Background and Rationalementioning

confidence: 99%

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change

Burkett

Martin‐Khan

Scott³

et al. 2017

Aust. Health Review

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show abstract

“…7,8 Up to 27% of older adults discharged home from the ED experience revisit, hospitalization, or death within 3 months after discharge. 9 In addition, a survey of older patients discharged from an inner-city ED revealed that most believed that ED staff were not attentive to their questions or needs. 10 The special care needs of older adults unfortunately are not aligned with the priorities of how ED physical space is designed and how ED care is rendered.…”

Section: Older Adults and The Edmentioning

confidence: 99%

The Geriatric Emergency Department

Hwang

Morrison

2007

J American Geriatrics Society

290

197

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With the aging of the population and the demographic shift of older adults in the healthcare system, the emergency department (ED) will be increasingly challenged with complexities of providing care to geriatric patients. The special care needs of older adults unfortunately may not be aligned with the priorities for how ED physical design and care is rendered. Rapid triage and diagnosis may be impossible in the older patient with multiple comorbidities, polypharmacy, and functional and cognitive impairments who often presents with subtle clinical signs and symptoms of acute illness. The use of Geriatric Emergency Department Interventions, structural and process of care modifications addressing the special care needs of older patients, may help to address these challenges. J Am Geriatr Soc 55:1873-1876, 2007. Key words: emergency medicine; geriatric health services F or most of the 20th century, the growth of the population aged 65 and older has far outpaced other age groups, and this trend will continue well into the 21st century. As a result of this demographic shift and an increase in longevity resulting from changes in lifestyles, health, and medical advances, one in five Americans will be aged 65 and older in 2030. By 2050, nearly 25% of Medicare beneficiaries will be aged 85 and older. 1 As the U.S. population continues to age, the healthcare system will need to face and embrace the challenges of caring for older adults. Care for elderly people is increasingly being sought in emergency departments (EDs), where older patients typically present with complex medical conditions, stay longer for more-extensive diagnostic testing and treatment regimens, and require special needs during their visit. The use of Geriatric Emergency Department Interventions may help to address these challenges and thereby improve the quality of care of elderly people in the ED. OLDER ADULTS AND THE EDAlthough the aging population will affect all areas of health care, the ED is likely to be disproportionately affected. In 2002, approximately 58% of 75-year-olds had at least one visit to an ED, as compared to 39% of those of all ages, and ED use increased with increasing age.3 Once in the ED, older patients are more likely to have an emergent or urgent condition, be hospitalized, and be admitted to a critical care unit. 4 In addition, older patients are also more likely to receive a greater number of diagnostic tests, spend longer times in the ED, and have higher charges for their ED services than younger patients. 5The Disconnect Between Emergency and Elder Care The ED is a unique environment where highly specialized care is delivered to the acutely ill and injured and safety net care is provided to disenfranchised and vulnerable populations. Although studies have begun to demonstrate disparities in care for older adults, most have focused on specific diseases or conditions 6 and have not looked specifically at how ED care and environmental factors may be associated with patient outcomes. Nonetheless, there are indications that the cu...

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“…[4][5][6] In an environment that increasingly incentivizes flow and rapid management, emergency physicians (EPs) are required to rapidly assess older patients who can have atypical presentations of disease, cognitive impairment or multiple other chronic conditions, be on multiple medications, and have either inadequate social supports or multiple community-care providers. [4][5][6][7] Older patients are more likely to experience adverse events in the ED, 8 including iatrogenic injury, 9 missed diagnoses, 10 omitted treatments, [11][12][13] poor medical outcomes, 14,15 death, 16 functional decline, [17][18][19] prolonged stays, 16 necessity for a discharge to a higher level of care, 20 and repeat ED use. 21,22 A 1992 American study reported that EPs found it challenging to provide consistently high-quality care for older patients.…”

Section: Introductionmentioning

confidence: 99%

A national survey of Canadian emergency medicine residents’ comfort with geriatric emergency medicine

Snider

Melady

Costa

2016

CJEM

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Background: Geriatric patients represent a large and complex subgroup seen in emergency departments (EDs). Competencies in geriatric emergency medicine (EM) training have been established. Our objectives were to examine Canadian postgraduate year (PGY)-5 EM residents' comfort with the geriatric EM competency domains, assess whether Canadian EM residents become more comfortable through residency, and determine whether geriatric educational exposures are correlated with resident comfort with geriatric EM. Methods: A national, cross-sectional study of PGY-1 and PGY-5 Royal College EM residents was conducted to determine their comfort in geriatric EM clinical competency domains. Residents reported their level of comfort in satisfying each competency domain using a seven-point Likert scale. Residents were also asked about the location of their medical education as well as the type and number of different geriatric exposures that they had received to date. Results: Of the 141 eligible residents from across Canada, 77% (109) consented to participate. None of the PGY-1 EM residents and 34% (14) of PGY-5 EM residents reported that they were comfortable with all eight geriatric EM competency domains. PGY-5 EM residents were significantly more comfortable than PGY-1 EM residents. Residents reported a highly variable range of geriatric educational exposures obtained during training. No relationship was found between resident-reported comfort and the nature or number of geriatric exposures that they had received. Conclusion: Current Royal College EM residency training in Canada may not be adequately preparing graduates to be comfortable with defined competencies for the care of older ED patients.

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Early revisit, hospitalization, or death among older persons discharged from the ED

Cited by 129 publications

References 25 publications

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change

The Geriatric Emergency Department

A national survey of Canadian emergency medicine residents’ comfort with geriatric emergency medicine

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