Pearl Treacy

The role of health and non-health-related factors in repeat emergency department visits in an elderly urban population

Introduction Patients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED attendance, defined as one or more visits in the previous 6 months in patients aged 65 years or older, and to examine the interaction between social and health factors. Methods 306 patients were interviewed. Demographic, socioeconomic, physical, mental health and post-ED referrals were examined. Logistic regression was used to identify factors independently associated with a repeat ED visit, OR and 95% CI are presented. Log likelihood ratio tests were used to test for interactions. Results ED revisits were reported by 37% of this elderly population. Independent risk factors for a repeat ED visit were previous hospital admission OR 3.78 (95% CI 2.53 to 5.65), anxiety OR 1.13 (95% CI 1.04 to 1.22), being part of a vulnerable social network OR 2.32 (95% CI 1.12 to 4.81), whereas a unit increase in physical inability as measured by the Nottingham Health Profile had a week association OR 1.01 (95% CI 1.00 to 1.02). There were no significant interactions between social networks and the other health-related variables (p>0.05). In patients directly discharged from ED, 48% (71/148) had no documented referrals made to community services, of which 18% (27/148) were repeat ED attendees. Conclusion ED act as an important safety net for older people regardless of economic or demographic backgrounds. Appropriate assessment and referral are an essential part of this safety role.

How different are older people discharged from emergency departments compared with those admitted to hospital

Objective To compare the characteristics of older people presenting to the emergency department (ED) and admitted to hospital with those discharged directly from the ED and identify factors independently associated with hospital admission. Design This is a cross-sectional survey of 306 community dwelling people aged 65 years or older presenting to two hospital EDs. A structured questionnaire and ED records were used to collect patient demographics, socioeconomic, physical, cognitive and social network information. Statistics The profile of admitted and discharged patients was compared using the &khgr;2 statistic. Logistic regression was used to identify factors independently associated with hospital admission. Odds ratios (OR) and 95% confidence intervals (CI) are presented. Results The analysis involved 306 patients, 158 admitted and 148 discharged home. There was no significant difference in demographic, socioeconomic, cognitive and social networks between the groups. Factors independently associated with hospital admission in the multivariate model were as follows: prior hospital admission OR 6.16 (95% CI 2.61, 14.50), Manchester Triage category 1–2 OR 5.01 (95% CI 1.19, 21.10), low-energy levels OR 3.97 (95% CI 1.32, 11.9) and presenting with cardiac OR 3.59 (95% CI 1.05, 12.3), neurological OR 4.47 (95% CI 1.21, 16.5) or respiratory-related conditions OR 11.2 (95% CI 2.41, 51.9). Among the cohort of discharged patients, 20–30% shared similar physical and mental health characteristics to admitted patients. Conclusion In this elderly population, health-related variables were the only independent factors associated with hospital admission. Approximately 30% of patients discharged home from ED had similar risk profiles to admitted patients.

The profile and follow-up of patients who attend the Emergency Department following a fall

UNLABELLED Falls in the older population are associated with increased morbidity and mortality especially in the absence of risk reduction measures. The study aims were to compare the characteristics of older people who present to the Emergency Department (ED) following a fall with the general older ED population and examine referral patterns following ED discharge. Face-to-face interviews were carried out with 306 people aged 65 years or older. Data was collected on demographic, socio-economic, health and social support factors. Descriptive and inferential statistics (Pearson chi-square test or independent t-test) were used to compare the falls and non-falls group. Falls occurred in 17% (53/306) of the study population and 43% sustained an injury requiring medical intervention. Patients in the falls group were significantly more likely to be female (68%), older (79 years (SD 6.6)) and living alone (59%). The physical and mental health profile of the falls and non-falls group was similar with 30-40% of people in both groups experiencing moderate to severe physical health impairment. A third of the falls group was discharged from the ED without evidence of referrals. CONCLUSION The older population that present to the ED following a fall requires comprehensive risk factor assessment especially physical function and referrals that include falls prevention. Implications for staff: ED staff need to examine current practice within their ED in relation to falls assessment, management and referral pathways.