Factors Associated With Emergency Department Use Among the Rural Elderly

Abstract

Context-Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood.Purpose-To characterize factors associated with having any versus no ED use among the rural elderly. Findings-20.8% of the sample had at least one ED visit during one year period. Being widowed, more education, Medicaid enrollment, fair/poor self perceived physical health, respiratory diseases and heart disease were associated with higher likelihood of having any ED visits while residing in the Western and Southern U.S. and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least one ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits.Conclusion-Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.

ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

“…Living in a rural setting could be a barrier for older adults to accessing the primary care services they need, which could result in emergency department use that could have been prevented. 41 In our study 40.9% of participants lived in a non-urban setting. This is similar to the Alabama rural dwelling population estimates at 41%.…”

“…43 It has been shown that insufficient physical activity leads to decreased muscle strength and functional impairment which has also been associated with falls. 41,42 …”

Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults

“…Additionally, we did not control for factors such as marital status or educational level that have been shown to be related to ED utilization in older adults because these data are not available from Medicare claims or enrollment data. 3,22 These factors, however, have a relatively weak relationship with the outcome of interest compared with illness burden and the geographical supply of health care resources, 23 which were controlled for in our analyses. Finally, this study uses observational methods and so cannot assert a causal relationship between the continuity of ambulatory care and ED episode rate.…”

The factors that influence private health insurance holders' choice between public and private emergency departments at the time of emergency

“…Previous literature indicated that health needs factors such as morbidity and injury were primary predictors for emergency care (Bazargan et al, 1998;Cherpitel, 1999;Cowie, Cowie, Underwood, Revitt, & Field, 2001;Fan et al, 2011;Guilbert et al, 2011;McCusker et al, 2003;Merrick et al, 2011;Neighbors, Zywiak, Stout, & Hoffmann, 2005;Shah, Manish N., Rathouz, & Chin, 2001;Shah, S. M. & Cook, 2008;Siegal, Falck, Jichuan, Carlson, & Massimino, 2006;Simmons et al, 2008;Weber, Showstack, Hunt, Colby, & Callaham, 2005;Wolinsky et al, 2008). Other health needs factors such as patients' perceived severity of illness and patients' health status were also associated with demand for emergency care (Baker, D. W. et al, 1995;Bazargan et al, 1998;Bianco et al, 2003;Callen et al, 2008;Lee et al, 2000;Olsson & Hansagi, 2001;Selasawati et al, 2007).…”

“…Previous literature indicates that the ED utilisation pattern varies by age groups, in which older people used EDs more frequently and for urgent illness (Baker, D. W. et al, 1996), while younger people used EDs for non-urgent conditions (Bianco, Pileggi, & Angelillo, 2003;Kushel et al, 2002;Rajpar, Smith, & Cooke, 2000a) and used it as a usual source of care (Lang et al, 1997;Walls et al, 2002 ED demand is also influenced by other socio-demographic factors such as gender (Butler, 1998;McCusker et al, 1997;Milbrett & Halm, 2009;Selasawati et al, 2007;Walls et al, 2002), education status (Fan et al, 2011), employment status (Rajpar et al, 2000a), and income status (Benjamin et al, 2003;Cunningham, Peter J. et al, 1995;Gifford et al, 2000;Hunt et al, 2006;O'Brien et al, 1997;Shah, S. M. & Cook, 2008;Zuckerman & Shen, 2004). …”