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Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established
INTRODUCTION: The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study wa...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156362/ https://www.ncbi.nlm.nih.gov/pubmed/27973563 http://dx.doi.org/10.1371/journal.pone.0165939 |
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author | Legramante, Jacopo M. Morciano, Laura Lucaroni, Francesca Gilardi, Francesco Caredda, Emanuele Pesaresi, Alessia Coscia, Massimo Orlando, Stefano Brandi, Antonella Giovagnoli, Germano Di Lecce, Vito N. Visconti, Giuseppe Palombi, Leonardo |
author_facet | Legramante, Jacopo M. Morciano, Laura Lucaroni, Francesca Gilardi, Francesco Caredda, Emanuele Pesaresi, Alessia Coscia, Massimo Orlando, Stefano Brandi, Antonella Giovagnoli, Germano Di Lecce, Vito N. Visconti, Giuseppe Palombi, Leonardo |
author_sort | Legramante, Jacopo M. |
collection | PubMed |
description | INTRODUCTION: The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”. MATERIAL AND METHODS: A retrospective study was performed during the calendar year 2014 (1(st) January 2014 – 31(st) December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models. RESULTS: A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2). DISCUSSION: Older patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established. CONCLUSION: Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly. |
format | Online Article Text |
id | pubmed-5156362 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-51563622016-12-28 Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established Legramante, Jacopo M. Morciano, Laura Lucaroni, Francesca Gilardi, Francesco Caredda, Emanuele Pesaresi, Alessia Coscia, Massimo Orlando, Stefano Brandi, Antonella Giovagnoli, Germano Di Lecce, Vito N. Visconti, Giuseppe Palombi, Leonardo PLoS One Research Article INTRODUCTION: The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”. MATERIAL AND METHODS: A retrospective study was performed during the calendar year 2014 (1(st) January 2014 – 31(st) December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models. RESULTS: A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2). DISCUSSION: Older patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established. CONCLUSION: Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly. Public Library of Science 2016-12-14 /pmc/articles/PMC5156362/ /pubmed/27973563 http://dx.doi.org/10.1371/journal.pone.0165939 Text en © 2016 Legramante et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Legramante, Jacopo M. Morciano, Laura Lucaroni, Francesca Gilardi, Francesco Caredda, Emanuele Pesaresi, Alessia Coscia, Massimo Orlando, Stefano Brandi, Antonella Giovagnoli, Germano Di Lecce, Vito N. Visconti, Giuseppe Palombi, Leonardo Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title | Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title_full | Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title_fullStr | Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title_full_unstemmed | Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title_short | Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established |
title_sort | frequent use of emergency departments by the elderly population when continuing care is not well established |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156362/ https://www.ncbi.nlm.nih.gov/pubmed/27973563 http://dx.doi.org/10.1371/journal.pone.0165939 |
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