Half Of Older Americans Seen In Emergency Department In Last Month Of Life; Most Admitted To Hospital, And Many Die There

Smith, Alexander K.; McCarthy, Ellen P.; Weber, Ellen J; Cenzer, Irena Stijacic; Boscardin, John; Fisher, Jonathan; Covinsky, Kenneth E.

doi:10.1377/hlthaff.2011.0922

Cited by 199 publications

(171 citation statements)

References 34 publications

Supporting

Mentioning

152

Contrasting

Unclassified

Order By: Relevance

“…Three-month ED use (48%) in this study was similar to rates found in communitydwelling persons approaching the end of life (51%) 36 and far exceeded the 19.1% 1-year ED use found in nationally representative community-dwellers with a similar average age (59.6 years). The cross-sectional design limited our ability to determine the causes of acute care use or anticipated acute care use after release, though in our analysis we included the health, geriatric and social factors that drive acute care use in community-dwelling older adults.…”

supporting

confidence: 74%

Older Jail Inmates and Community Acute Care Use

et al. 2014

Self Cite

View full text Add to dashboard Cite

Objectives: To describe older jail inmates' predetainment use of acute care (Emergency Department (ED) or hospitalization in the 3 months prior to arrest) and their plans for using acute care after release.Methods: Cross-sectional study of 247 jail inmates age 55 or older assessing sociodemographic characteristics, health and geriatric conditions associated with predetainment and anticipated post-release acute care use.Results: 52% of older inmates reported predetainment acute care use and 47% planned to use the ER after release. In modified Poisson regression, homelessness was independently associated with predetainment use (RR 1.42, CI 1.10 -1.83) and having a primary care provider was inversely associated with planned use (RR 0.69, CI 0.53 -0.89).Conclusions: The Affordable Care Act extends Medicaid eligibility to all persons leaving jail in an effort to decrease post-release acute care use in this high-risk population. In addition, jail-to-community transitional care models that address the health, geriatric and social factors prevalent in older adults leaving jail, with specific focuses on linkages to housing and primary care, are needed to enhance the impact of ACA policies on acute care use for this population.2

show abstract

supporting

confidence: 74%

Older Jail Inmates and Community Acute Care Use

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…A study of patients older than age 65 years by Smith et al revealed 75% visited an ED in the last 6 months of life and 51% in the last month, many with repeat visits. 3 The transition from curative to noncurative symptom management may greatly change the hospital trajectory of care. Here is the opportunity to initiate further goals of care that may change future plans.…”

Section: • Not Surprisedmentioning

confidence: 99%

Palliative Care in the Emergency Department

Mierendorf¹,

Gidvani²

2014

TPJ

View full text Add to dashboard Cite

“…[3][4][5] Recent research found that half of older Americans visited the emergency department in the last month of life and 75% did so in their last six months of life. 6 While a recent analysis of Medicare beneficiaries found that more people are dying at home with hospice services, hospice length of stay is short because of an increase in hospital and intensive care unit stays in the last month of life that occur before referral to hospice. Further, there has been an increase in the number of people who experience multiple transitions across health care settings near the end of life.…”

Section: Outline Of the Scope Of The Problemmentioning

confidence: 99%

Research Priorities in Geriatric Palliative Care: Policy Initiatives

Unroe

Meier

2013

Journal of Palliative Medicine

View full text Add to dashboard Cite

Coordinated palliative care matched to patient needs improves quality of care for vulnerable patients with serious illness and reduces costly use of hospitals and emergency departments. Unfortunately, there is a disconnect in translating geriatric palliative care models and principles into policy and widespread practice. Gaps in policy-relevant research are addressed, including implementation strategies to scale up existing care models, the role of palliative care and geriatrics in health care payment reform efforts, development of quality measures for complex patients, strategies to address workforce shortages, and an approach to hospice reform.''I told the doctor that I never wanted to go back to the hospital again. It's torture-you have no control and can't do anything for yourself. And you get weaker and sicker. Every time I'm in the hospital it feels like I'll never get out.'' This 88-year-old man with mild dementia presents to the emergency department for management of back pain due to spinal stenosis and arthritis. He had been admitted to the hospital four times in the past six months-twice for pain, once for weight loss and falls, and once for altered mental status due to constipation. His overwhelmed 83-year-old wife tells the emergency department physician, ''He hates being in the hospital, but what could I do? The pain was terrible and I couldn't reach the doctor. I couldn't even move him myself, so I called the ambulance. It was the only thing I could do.'' T he fields of palliative care and geriatrics have developed a growing body of evidence in support of customized care models aimed at meeting the needs of frail, vulnerable, and seriously ill patient populations. The problem is not that we don't know what to do-the problem is that we don't do what we know. The business of translating evidence into real-world practice for frail older adults is critically dependent on changes in public and payment policy. As in any aspect of health care, gaps do remain in our understanding of treatments and the optimal approach to delivering services to vulnerable populations. Allocation of research dollars to address these questions is an urgent public health priority. Health care spending in the United States not only fails to deliver quality but quite realistically poses the greatest threat to the American economy and way of life-the 18% of GDP in dollars spent on high cost, low value health care cannot be allocated to other crucial public needs: education, repair of roads and bridges, food and air quality and safety, and protection from the consequences of rising income inequality and poverty. The good news here is that improving quality of care for high risk, vulnerable patients-so that the patient described above does not have to turn to the emergency department for every symptom crisis, but instead receives coordinated palliative care matched to his changing needs at home-leads to much lower need for spending in emergency departments and hospitals. It is critical that federal, state, and local regulat...

show abstract

Half Of Older Americans Seen In Emergency Department In Last Month Of Life; Most Admitted To Hospital, And Many Die There

Cited by 199 publications

References 34 publications

Older Jail Inmates and Community Acute Care Use

Older Jail Inmates and Community Acute Care Use

Palliative Care in the Emergency Department

Research Priorities in Geriatric Palliative Care: Policy Initiatives

Contact Info

Product

Resources

About