Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study

Abstract

ObjectivesTo examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DesignA register-based prospective cohort study.SettingSwedish region of Dalarna.ParticipantsParticipants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.Outcome measuresDependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.ResultsApproximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit.ConclusionContextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.

Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool

“…The number of previous hospitalisations is a measure of disease burden and the fact that readmitted patients are more ill does not really come as a surprise since this has been shown previously. 2 22 28 In a Swedish study from 2022, Naseer et al 31 showed that emergency department visits in older adults are significantly associated with several variables indicating disease burden, such as number of chronic diseases, number of primary care visits, number of emergency department visits, polypharmacy and receipt of home care.…”

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

“…In Sweden, ageing in place is facilitated by the municipalities that provide services aligned with everyday care needs. However, home care service dependence is known to predict emergency care needs and emergency department (ED) conveyance [12]. Emergency care is the responsibility of the regional emergency medical service (EMS) and is provided by the ambulance services.…”