Age and Ageing Advance Access originally published online on March 12, 2009
Age and Ageing 2009 38(3):314-318; doi:10.1093/ageing/afp022
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Use of emergency departments by older people from residential care: a population based study
1 Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Australia
2 School of Population Health, The University of Western Australia, Australia
3 Centre for Nursing Research, Sir Charles Gairdner Hospital, Australia
4 Western Australian Centre for Health & Ageing, The University of Western Australia, Australia
Address correspondence to: Judith C Finn. Tel: (+61) 8 6488 7375; Fax: (+61) 8 6488 1188. Email: judith.finn{at}uwa.edu.au
Objective: to investigate the differences between emergency department (ED) presentations of older people who do and do not live in residential care facilities (RCFs).
Design: a population-based retrospective cohort study. ED records linked to ambulance and hospital morbidity records.
Setting: public EDs in Perth, Western Australia.
Subjects: all patients 65 years and older who presented to EDs between 1 January 2003 and 31 December 2006 (n = 97,161).
Measurements: patient demographic and clinical characteristics. Logistic regression was used to model the effect of living in RCFs on the likelihood of a particular ED diagnosis, hospital admission and in-hospital death.
Results: the age–sex standardised rate of ED presentation for those living in RCFs was 1.69 times that of community dwellers. Compared to community dwellers, people from RCFs were older (mean age 84.7 years vs. 76.0 years, P < 0.001) and a lower proportion were male (28.7% vs. 46.7%, P < 0.001). Adjusting for age and sex revealed that people from RCFs were more likely to be diagnosed with pneumonia/influenza [odds ratio (OR) 1.94, 95% confidence interval (CI) = 1.72–2.19], urinary tract infections (OR 1.72, 95% CI 1.49–1.98) or hip fractures (OR 1.16, 95% CI 1.03–1.32); less likely to be diagnosed with circulatory system diseases (OR 0.69, 95% CI 0.64–0.75) or neoplasms (OR 0.47, 95% CI 0.31–0.72); more likely to be admitted (OR 1.13, 95% CI 1.06–1.20) and to die in hospital (OR 1.57, 95% CI 1.40–1.75).
Conclusion: there are different patterns of ED presentations and hospital admissions of older people who do and do not live in RCFs. The appropriateness of these differences is uncertain.
Keywords: emergency medicine, aged, residential facilities, elderly
Received 17 June 2008; accepted in revised form 17 December 2008.