Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data

Lowthian, Judy; Turner, Lyle; Joe, Angela; Pearce, Christopher; Brijnath, Bianca; Browning, Colette Joy; Shearer, Marianne; Mazza, Danielle

doi:10.1111/1742-6723.12923

Cited by 5 publications

(4 citation statements)

References 18 publications

(27 reference statements)

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“…Our results show that age over 65 was the most significant sociodemographic determinant of FP. Other studies have similarly found increased rates of FP in the elderly 5,7,22 . Although older patients are more likely to have chronic diseases requiring ongoing care, 17,22 this highlights the need for further research and interventions to improve care coordination between health services and aged care services 5 .…”

Section: Discussionmentioning

confidence: 92%

“…Other studies have similarly found increased rates of FP in the elderly. 5 , 7 , 22 Although older patients are more likely to have chronic diseases requiring ongoing care, 17 , 22 this highlights the need for further research and interventions to improve care coordination between health services and aged care services. 5 Previous literature has shown evidence for case management 20 and enhanced geriatric outreach services such as Hospital in the Nursing Home.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and characteristics of frequent presenters to Auburn Hospital emergency department

Cordell

Nguyen

Shahir

et al. 2022

Emerg Medicine Australasia

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Objectives: Frequent presenters (FPs) to the ED are common and contribute to ED overcrowding. Our aim was to identify the proportion of FPs over a 12-month period and to investigate the sociodemographic, clinical and attendance characteristics of FPs. Methods: A retrospective cohort study of adult patients (≥18 years) presenting to Auburn Hospital ED between 1 January 2018 to 31 December 2018. Patients with ≥4 presentations in 12 months were classified as FP. Multivariable logistic regression was used to assess associations between sociodemographic characteristics and FP. Results: During the study period, there were 22 679 presentations to the ED from 16 624 adult patients. FPs represented 5.1% (95% confidence interval [CI] 4.8-5.5) of the total population, but 15.8% of the total ED visits. Median age of FPs was 46 years (interquartile range 29-72), 51.9% were males. Age over 65 was the strongest determinant of FP (odds ratio [OR] 2.33; 95% CI 2.01-2.72 adjusted for sex). FP was more likely for Arabic speakers compared to English speakers (OR 1.54; 95% CI 1.28-1.86 adjusted for age and sex) and least likely for Mandarin speakers (adjusted OR 0.40; 95% CI 0.27-0.59). Conclusions: FPs represent a significant proportion of ED visits, yet a small proportion of ED patients. Our findings suggest that identifying ways to provide targeted services to older FPs may reduce the overall rates. The differences between language groups and FP highlights the importance of social context and culture when developing targeted interventions.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of frequent presenters to Auburn Hospital emergency department

Cordell

Nguyen

Shahir

et al. 2022

Emerg Medicine Australasia

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“…Lowthian et al . found an increase in non‐potentially avoidable GP type ED presentations when examining inappropriate ED presentations in patients over the age of 70 years, with most related to cardiovascular or respiratory illness . A recent Western Australian study demonstrated the receipt of palliative home care nursing significantly reduced the rate of both lower acuity and higher acuity ED presentations .…”

Section: Discussionmentioning

confidence: 99%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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Objective To examine characteristics, outcomes and flow for patients over the age of 45 years with a life‐limiting illness (LLI) presenting to a regional ED. Methods Retrospective, observational cohort study of patients with LLI in an Australian regional ED over a 15‐day period. Eligible patients were 45 years of age or older who fulfilled criteria for having an LLI. Data included demographics, diagnosis for current presentation, presence of advance care documentation, LLI category, admission and discharge destination from ED, ED and hospital length of stay and outcome for patients admitted to the acute hospital. Results A total of 152 (12%) patients had an LLI. The LLI group were older, had a significantly longer median length of stay in the ED (5.9 [interquartile range 4.0–8.4] vs 3.9 h [interquartile range 2.5–6.3], P < 0.0001) and were less likely to leave the ED within 4 h (26% vs 51.5%, P < 0.0001). Forty‐six percent of patients with an LLI had some form of advanced care documentation. Patients with an LLI were more likely to require hospital admission. In relation to illness trajectory, the frailty/dementia trajectory group had comparatively the longest ED length of stay with less than 10% leaving the ED within 4 h. This group were more likely to be discharged to a residential care facility. Conclusion A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.

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“…Group 1 will receive the ‘HOW R U?’ intervention over the telephone. We have attempted to replicate the intervention as it was delivered in the previous trial 47 56. ‘HOW R U?’ trained volunteer-peers provide strength-based support sessions weekly over the phone for 12 weeks.…”

Section: Methods and Analysismentioning

confidence: 99%

Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

Lee,

Rose,

Borgundvaag

et al. 2024

BMJ Open

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IntroductionThe COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness has increased from 40% to 70% during COVID-19. Previous research indicates loneliness is strongly associated with increased mortality. Thus, strategies to mitigate the unintended consequences of social isolation and loneliness are urgently needed. Following the Obesity-Related Behavioural Intervention Trials model for complex behavioural interventions, we describe a protocol for a three-arm randomised clinical trial to reduce social isolation and loneliness.Methods and analysisA multicentre, outcome assessor blinded, three-arm randomised controlled trial comparing 12 weeks of: (1) the HOspitals WoRking in Unity (‘HOW R U?’) weekly volunteer-peer support telephone intervention; (2) ‘HOW R U?’ deliver using a video-conferencing solution and (3) a standard care group. The study will follow Consolidated Standard of Reporting Trials guidelines.We will recruit 24–26 volunteers who will receive a previously tested half day lay-training session that emphasises a strength-based approach and safety procedures. We will recruit 141 participants ≥70 years of age discharged from two participating emergency departments or referred from hospital family medicine, geriatric or geriatric psychiatry clinics. Eligible participants will have probable baseline loneliness (score ≥2 on the de Jong six-item loneliness scale). We will measure change in loneliness, social isolation (Lubben social network scale), mood (Geriatric Depression Score) and quality of life (EQ-5D-5L) at 12–14 weeks postintervention initiation and again at 24–26 weeks.Ethics and disseminationApproval has been granted by the participating research ethics boards. Participants randomised to standard care will be offered their choice of telephone or video-conferencing interventions after 12 weeks. Results will be disseminated through journal publications, conference presentations, social media and through the International Federation of Emergency Medicine.Trial registration numberNCT05228782.

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Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data

Cited by 5 publications

References 18 publications

Prevalence and characteristics of frequent presenters to Auburn Hospital emergency department

Prevalence and characteristics of frequent presenters to Auburn Hospital emergency department

Patients with life‐limiting illness presenting to the emergency department

Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

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