Local trends in emergency department attendances by older patients in an ageing national population

Abstract

Nursing-led aged care services were set up at our Emergency Department (ED) in 2004-05 to assist in the appropriate discharge of older patients. This study examined local trends in ED attendances by older patients. A retrospective study was conducted at an inner-city adult ED in a region with a 2.2% annual growth rate. Patient demographics, Australasian Triage Scale (ATS) category and admission/discharge status were collected from January 2002 to December 2006. Total ED attendances increased 7.7% from 66 687 in 2002 to 71 801 in 2006. Older patients' attendances, however, decreased 3.1% from 12 356 to 11 971. This decrease in ED attendances by older patients was unexpected. This may represent local population trends and/or be related to ED services designed to manage older patients and nursing home residents in the community. The planning of health services for older people therefore needs to take into consideration the influences on local trends in Population ageing will impact on the demand for and provision of health services. Data from the Australian Bureau of Statistics (ABS) National Health Surveys revealed that 38% of people aged 65-75 years visited their doctor in the 2 weeks before interview, and that 23% had been hospitalised within the previous 12 months. 2 Compared with younger age groups, older patients may require different types of care in hospital. 3 The proportion of episodes for rehabilitation, geriatric evaluation and management, and maintenance care all increase with age. Despite their relatively greater need for nonemergency and critical care, the emergency department (ED) is likely to remain an important point of entry into the health care system for many older people.A cross-sectional study in 2001 at our ED has shown that older patients used relatively more ED resources than younger patients. 4 What is known about the topic? Ageing of the Australian population is well recognised, with older adults increasing their use of emergency departments (EDs). What does this paper add?This paper examined trends in attendances for older (у 65 years) and younger (14-65 years) patients, finding a decrease in ED presentations, but that admissions for older ED patients remained relatively stable at 1 in 2 patients. What are the implications for practitioners? Our data suggest that the number of presentations by older patients could decrease in certain regions, influenced by a dilution effect of a younger population and possibly by a "healthier older migrant" effect plus local nurse-led aged-care programs in the ED. The planning of emergency health services needs to take into account the influences on local trends in changing population demographics.

An outcomes evaluation of an Australian Hospital in the Nursing Home admission avoidance programme

“…Older adults from ACFs have longer waits (average six hours) in the ED before being admitted or discharged (Crilly et al 2008). In a nearby ED, older adults requiring admission were found to have longer ED LOS than those being discharged from the ED (7AE0 vs. 3AE4 hours) during the same time period of this study (Chu et al 2009). The longer ED LOS (7AE5 hours) for HINH patients in our study possibly reflects the additional time HINH patients spent waiting in the ED (having been admitted to the ED observation ward) for HINH review and transport back to the ACF to have care continued.…”

“…2008). In a nearby ED, older adults requiring admission were found to have longer ED LOS than those being discharged from the ED (7·0 vs. 3·4 hours) during the same time period of this study (Chu et al. 2009).…”

“…Whilst a NZ study using a comprehensive geriatric assessment screen reported that approximately 40-60 minutes were required for this assessment to be performed by specially trained staff (Boyd et al 2008), the ED time outcome specifically concerning the HINH programme has not, to our knowledge, been investigated previously and may suggest that the programme was working. Although older people account for 53% of hospital admissions in Australia (AIHW 2007), they are a population group identified to be decreasing in ED and hospital use (Gray et al 2004, Chu et al 2009). This may be attributable to the increasing number of in-hospital and out-of-hospital support services that have emerged since the early 1990s.…”

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

“…42 Therefore, if using the finding of the present study to inform local policy and planning, it would be necessary to explore specific local trends.…”

Estimating future demand for hospital emergency services at the regional level

“…Most authors have considered age-associated patterns and reached a range of conclusions. McConnel and Wilson (1998) and Lowthian et al (2011a) found that demand for EMS services increased exponentially with age, and Chu et al (2009) observed a relative decrease in ED attendance by patients 65 and older across certain triage groups. Interestingly, Lowthian et al (2011b) proved that although demand for ambulances was growing faster that can be explained by population growth, it was possible to attribute only 25% of the EMS calls to ageing and population growth.…”