Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans, Christopher S.; Platts‐Mills, Timothy F.; Fernández, Antonio R. Martínez; Grover, Joseph M.; Cabañas, José G.; Patel, Mehul D.; Vilke, Gary M.; Brice, Jane H.

doi:10.1016/j.annemergmed.2017.03.058

Cited by 30 publications

(42 citation statements)

References 39 publications

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“…But the figure is also higher than international studies involving solely patients ≥65 years old showing that 44% to 88% of patients were conveyed. [8][9][10] Differences in ambulance service organisations between and within countries, however, make international comparison difficult based on varying, for example, care level options, 21 and continuity of care. 22 Previous studies have found that 7%-16% of patients engaging AAs have symptoms that can be treated at the primary care level, 23 24 indicating that more patients can receive optimal out-of-hospital care through extended Open access collaboration between organisations within the emergency care system.…”

Section: Results Discussionmentioning

confidence: 99%

“…7 Internationally, patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and 44%-88% are conveyed to hospitals. [8][9][10] During each AA, the ambulance personnel provide assessment and decide on optimal care level for patients' disposition, 11 meaning where patients are treated or conveyed for optimal care. Patients' dispositions during AAs are in this study divided into conveyance or non-conveyance to hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study

et al. 2020

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ObjectivesPatients ≥65 years old represent 30%–50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients’ aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals.DesignA longitudinal and comparative database study.SettingAmbulance service in a Swedish region.Participants32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients’ dispositions data.Outcome measuresDependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season.ResultsThe majority (n=29 060; 90.6%) of patients’ dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85–89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections.ConclusionsThe study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.

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Section: Results Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study

et al. 2020

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“…Therefore, the World Health Organization strongly recommends that health care systems globally redesign their services to better fulfill older people's needs and to promote their independence [1]. Older age entails prevalence of cognitive and physical impairments, chronic medical conditions, and frailty, thus increasing the need for emergency ambulance care [2][3][4][5][6]. Currently, approximately 1.5 million people in Sweden are aged > 70 years [7], a population that is estimated to rise by 25% over the next 15 years [8].…”

Section: Introductionmentioning

confidence: 99%

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

et al. 2020

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Background Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18–69 years requiring emergency care at home in Sweden. Methods A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. Results Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00–11:59 interval (p < 0.001, χ2 = 1224.08). Conclusion The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.

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“…In the United States, older adults have a high rate of emergency department (ED) attendance, with one of every five visiting the ED at least once a year . Older adults account for up to 25% of all emergency department (ED) patient encounters and for 38% of emergency medical services (EMS) transports . This number will rise dramatically: in 2018, roughly one in seven Americans was an older adult; by 2030, that figure will be one in five.…”

mentioning

confidence: 99%

White Paper—Geriatric Emergency Medicine Education: Current State, Challenges, and Recommendations to Enhance the Emergency Care of Older Adults

Ringer¹,

Dougherty

McQuown

et al. 2018

AEM Education and Training

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Older adults account for 25% of all emergency department (ED) patient encounters. One in five Americans will be 65 or older by 2030. In response to this need, geriatric emergency medicine (GEM) has developed into a robust area of academic and clinical interest, with extensive evidence-based research and guidelines, including clear undergraduate and postgraduate GEM competencies.Despite these developments, GEM content remains underrepresented in curricula and licensing examinations. The complex reasons for these deficits include a perception that care of older adults is not a core emergency medicine (EM) competency, a disjunction between traditional definitions of expertise and the GEM perspective, and lack of curricular capacity.This White Paper, prepared on behalf of the Academy of Geriatric Emergency Medicine, describes the state of GEM education, identifies the challenges it faces, and reviews innovations, including research presented at the 2018 Society for Academic Emergency Medicine (SAEM) Annual Scientific Meeting. The authors propose a number of recommendations. These include recognizing GEM as a core educational priority in EM, enhancing academic support for GEM clinician-educators, using social learning and practical problem solving to teach GEM concepts, emphasizing a whole-person multisystem approach to care of older adults, and identifying ageist attitudes as a hurdle to safe and effective GEM care.

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Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Cited by 30 publications

References 39 publications

Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study

Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

White Paper—Geriatric Emergency Medicine Education: Current State, Challenges, and Recommendations to Enhance the Emergency Care of Older Adults

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