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Jones A, Watt JA, Maclagan LC, Swayze S, Jaakkimainen L, Schull MJ, Bronskill SE. Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study. J Am Geriatr Soc 2023; 71:3731-3743. [PMID: 37314108 DOI: 10.1111/jgs.18457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/12/2023] [Accepted: 05/14/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits. METHODS We used health administrative databases to conduct a population-based retrospective cohort study among older adults with dementia in Ontario, Canada. We included community-dwelling adults 66 years and older who visited the ED between April 1, 2010, and March 31, 2019 and were discharged home. We recorded all ED visits within one year after the baseline visit. We used recurrent event Cox regression to examine associations between repeat ED visits and individual clinical, demographic, and health service use characteristics. We fit conditional inference trees to identify the most important factors and define subgroups of varying risk. RESULTS Our cohort included 175,863 older adults with dementia. ED use in the year prior to baseline had the strongest association with recurrent visits (3+ vs.0 adjusted hazard ratio (aHR): 1.92 (1.89, 1.94), 2vs.0 aHR: 1.45 (1.43, 1.47), 1vs.0 aHR: 1.23 (1.21, 1.24)). The conditional inference tree utilized history of ED visits and comorbidity count to define 12 subgroups with ED revisit rates ranging from 0.79 to 7.27 per year. Older adults in higher risk groups were more likely to live in rural and low-income areas and had higher use of anticonvulsants, antipsychotics, and benzodiazepines. CONCLUSIONS History of ED visits may be a useful measure to identify older adults with dementia who would benefit from additional interventions and supports. A substantial proportion of older adults with dementia have a pattern of recurrent visits and may benefit from dementia-friendly and geriatric-focused EDs. Collaborative medication review in the ED and closer follow-up and engagement with community supports could improve patient care and experience.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jennifer A Watt
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Schull
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Janda S, Sindhu S, Watthayu N, Limruangrong P, Viwatwongkasem C, Boonsawat W. Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation. AGEING INTERNATIONAL 2020. [DOI: 10.1007/s12126-020-09387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sheikh S. Risk Factors Associated with Emergency Department Recidivism in the Older Adult. West J Emerg Med 2019; 20:931-938. [PMID: 31738721 PMCID: PMC6860386 DOI: 10.5811/westjem.2019.7.43073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/29/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023] Open
Abstract
Our objective was to review risk factors predictive of older adult recidivism in the emergency department. Certain risk factors and themes commonly occurred in the literature. These recurring factors included increasing age, male gender, certain diagnoses (abdominal pain, traumatic injuries, and respiratory complaints), psychosocial factors (depression, anxiety, poor social support, and limited health literacy), and poor general health (cognitive health and physical functioning). Many of the identified risk factors are not easily modifiable posing a significant challenge in the quest to develop and implement effective intervention strategies.
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Affiliation(s)
- Sophia Sheikh
- University of Florida-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
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Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review. BMC Geriatr 2019; 19:185. [PMID: 31277582 PMCID: PMC6610907 DOI: 10.1186/s12877-019-1197-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs. OBJECTIVE This review aimed at identifying variables associated with frequent ED use by older adults. METHODS For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence. A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. RESULTS Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. CONCLUSION Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty.
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Miller KEM, Duan-Porter W, Stechuchak KM, Mahanna E, Coffman CJ, Weinberger M, Van Houtven CH, Oddone EZ, Morris K, Schmader KE, Hendrix CC, Kessler C, Hastings SN. Risk stratification for return emergency department visits among high-risk patients. THE AMERICAN JOURNAL OF MANAGED CARE 2017; 23:e275-e279. [PMID: 29087151 PMCID: PMC6415920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and "Super User" status, defined as more than 3 ED visits within 6 months of the index ED visit. STUDY DESIGN Retrospective cohort study. METHODS Using McNemar's test, we compared rates of high-risk classification between CAN score and Super User status. We examined differences in patient characteristics and healthcare utilization across 4 levels of risk classification: high CAN and Super User status (n = 198), CAN <90 and non-Super User (n = 622), high CAN and non-Super User (n = 616), or Super User and CAN score <90 (n = 106). We used logistic regression to identify associations between risk classification and any ED visit within 90 days. RESULTS Of 1542 veterans, 52.8% (n = 814) had a CAN score ≥90 and 19.7% (n = 304) were Super Users (P <.0001), indicating discrepant rates of high-risk classification. However, we found no differences in patient characteristics. Rates of subsequent ED use were high: 63.1% of patients had 1 or more ED visits. No levels of risk classification were associated with subsequent ED use within 90 days (P = .25). CONCLUSIONS Among the VHA users with multimorbidity and 3 or more prior ED visits or hospitalizations, subsequent ED use was high. Although CAN scores have demonstrated utility for predicting hospitalizations and deaths, prior utilization and multimorbidity without further risk classification identified a high-risk group for repeat ED use.
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Neelon B, Chang HH, Ling Q, Hastings NS. Spatiotemporal hurdle models for zero-inflated count data: Exploring trends in emergency department visits. Stat Methods Med Res 2016; 25:2558-2576. [DOI: 10.1177/0962280214527079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motivated by a study exploring spatiotemporal trends in emergency department use, we develop a class of two-part hurdle models for the analysis of zero-inflated areal count data. The models consist of two components—one for the probability of any emergency department use and one for the number of emergency department visits given use. Through a hierarchical structure, the models incorporate both patient- and region-level predictors, as well as spatially and temporally correlated random effects for each model component. The random effects are assigned multivariate conditionally autoregressive priors, which induce dependence between the components and provide spatial and temporal smoothing across adjacent spatial units and time periods, resulting in improved inferences. To accommodate potential overdispersion, we consider a range of parametric specifications for the positive counts, including truncated negative binomial and generalized Poisson distributions. We adopt a Bayesian inferential approach, and posterior computation is handled conveniently within standard Bayesian software. Our results indicate that the negative binomial and generalized Poisson hurdle models vastly outperform the Poisson hurdle model, demonstrating that overdispersed hurdle models provide a useful approach to analyzing zero-inflated spatiotemporal data.
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Affiliation(s)
- Brian Neelon
- Center for Health Services Research in Primary Care, Durham VAMC, USA
- Department of Biostatistics and Bioinformatics, Duke University, USA
| | | | - Qiang Ling
- Department of Biostatistics, Emory University, USA
| | - Nicole S Hastings
- Center for Health Services Research in Primary Care, Durham VAMC, USA
- Department of Medicine, Duke University School of Medicine, USA
- Geriatrics Research, Education and Clinical Center, Durham VAMC, USA
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Jin B, Zhao Y, Hao S, Shin AY, Wang Y, Zhu C, Hu Z, Fu C, Ji J, Wang Y, Zhao Y, Jiang Y, Dai D, Culver DS, Alfreds ST, Rogow T, Stearns F, Sylvester KG, Widen E, Ling XB. Prospective stratification of patients at risk for emergency department revisit: resource utilization and population management strategy implications. BMC Emerg Med 2016; 16:10. [PMID: 26842066 PMCID: PMC4739399 DOI: 10.1186/s12873-016-0074-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background Estimating patient risk of future emergency department (ED) revisits can guide the allocation of resources, e.g. local primary care and/or specialty, to better manage ED high utilization patient populations and thereby improve patient life qualities. Methods We set to develop and validate a method to estimate patient ED revisit risk in the subsequent 6 months from an ED discharge date. An ensemble decision-tree-based model with Electronic Medical Record (EMR) encounter data from HealthInfoNet (HIN), Maine’s Health Information Exchange (HIE), was developed and validated, assessing patient risk for a subsequent 6 month return ED visit based on the ED encounter-associated demographic and EMR clinical history data. A retrospective cohort of 293,461 ED encounters that occurred between January 1, 2012 and December 31, 2012, was assembled with the associated patients’ 1-year clinical histories before the ED discharge date, for model training and calibration purposes. To validate, a prospective cohort of 193,886 ED encounters that occurred between January 1, 2013 and June 30, 2013 was constructed. Results Statistical learning that was utilized to construct the prediction model identified 152 variables that included the following data domains: demographics groups (12), different encounter history (104), care facilities (12), primary and secondary diagnoses (10), primary and secondary procedures (2), chronic disease condition (1), laboratory test results (2), and outpatient prescription medications (9). The c-statistics for the retrospective and prospective cohorts were 0.742 and 0.730 respectively. Total medical expense and ED utilization by risk score 6 months after the discharge were analyzed. Cluster analysis identified discrete subpopulations of high-risk patients with distinctive resource utilization patterns, suggesting the need for diversified care management strategies. Conclusions Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. It promises to provide increased opportunity for high ED utilization identification, and optimized resource and population management. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0074-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Jin
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Yifan Zhao
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Shiying Hao
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Andrew Young Shin
- Departments of Pediatrics, Stanford University, Stanford, CA, 94305, USA
| | - Yue Wang
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | | | - Zhongkai Hu
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Changlin Fu
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Jun Ji
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Yong Wang
- Statistics Stanford University, Stanford, CA, 94305, USA.,Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, 10019, China
| | - Yingzhen Zhao
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yunliang Jiang
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Dorothy Dai
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | | | | | | | | | - Karl G Sylvester
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Eric Widen
- HBISolutions Inc., Palo Alto, CA, 94301, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Šteinmiller J, Routasalo P, Suominen T. Older people in the emergency department: a literature review. Int J Older People Nurs 2015; 10:284-305. [PMID: 26183883 DOI: 10.1111/opn.12090] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency departments (EDs) play a unique role in healthcare systems throughout the world by providing acute interventions for older patients with acute/emergency and multiple health problems. The aim of this review was to identify studies that focused on older patients admitted to EDs and to determine the reasons for the visits. DESIGN AND METHODS The literature review was based on a comprehensive search of electronic databases. Inclusion criteria were original research written in English; published 2002-2012; focused on older people; reasons for ED visit; and factors that affect the discharge process and those associated with a repeat ED visit. Other literature reviews and studies unrelated to the ED context, and studies examining patients aged ≥65 years, were excluded. Content analysis was performed. Twenty-five studies were identified and critically evaluated. RESULTS The highest proportion of older people visited the ED because of multiple health conditions. The reasons for the visits were cardiovascular, mental health, musculoskeletal and abdominal conditions; adverse drug reactions; dermatological, neurological and respiratory conditions; poor health status; accidents; and the influence of time factors such as time of day, week or season. Factors that affected the discharge process were unresolved problems, health risk identification, aftercare instructions, medication prescribed at discharge and patient's residence before ED admission. Factors associated with repeat ED visits were sociodemographic characteristics, social problems, health problems, need for systematic health assessment, healthcare service use and inadequacy of care provided. CONCLUSIONS The current review showed that older people are the main population visiting EDs; important factors required for planning and providing nursing care for older people in EDs were identified. More research is needed to determine how EDs support older people and their families. IMPLICATIONS FOR PRACTICE The findings of the current review identified that older people visit ED quite often because of different reasons. Discharge process and repeat visits may be influenced by various factors. To ensure quality nursing care in ED nurses need to be aware why do older people visit the ED, what factors may influence discharge and what factors are associated with repeat ED visits.
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Affiliation(s)
| | | | - Tarja Suominen
- School of Health Sciences, Nursing Sciences, University of Tampere, Tampere, Finland
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Chan CL, Lin W, Yang NP, Lai KR, Huang HT. Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis. PLoS One 2015; 10:e0127793. [PMID: 26030278 PMCID: PMC4452693 DOI: 10.1371/journal.pone.0127793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. Objectives We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events. Methods This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events. Results The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively. Conclusions The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.
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Affiliation(s)
- Chien-Lung Chan
- Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
| | - Wender Lin
- Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
| | - Nan-Ping Yang
- Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - K. Robert Lai
- Department of Computer Science and Engineering, and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
| | - Hsin-Tsung Huang
- Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan
- Medical Affairs Division, National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
- * E-mail:
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Stén KD, Soares JJF, Viitasara E, Stankūnas M, Sundin Ö, Melchiorre MG, Macassa G, Barros H, Lindert J, Torres-Gonzalez F, Ioannidi-Kapolou E. The relationship between abuse, psychosocial factors, and pain complaints among older persons in Europe. MEDICINA-LITHUANIA 2014; 50:61-74. [PMID: 25060206 DOI: 10.1016/j.medici.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/02/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression). Therefore, the aim of this study was to determine these relationships. MATERIALS AND METHODS The design was cross-sectional. A total of 4467 women and men aged 60-84 years from Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden answered questionnaires regarding various areas such as abuse, mental health (e.g. anxiety) and pain complaints (e.g. backache). The data were examined with bivariate (analyses of variance) and multivariate methods (linear regressions). RESULTS The bivariate analyses showed that psychological abuse was connected with all pain complaints; physical with headache and head pressure; sexual with neck or shoulder pain and headache; injury with all complaints (except pain in joints or limbs); financial with pain in joints or limbs and head pressure; and overall abuse (one or more types) with all complaints (except headache). The regressions showed that psychological abuse increased the likelihood of being affected by head pressure and heaviness or tiredness in the legs; physical abuse of being affected by headache and head pressure; financial abuse of being affected by head pressure; and overall abuse of being affected by headache and head pressure. In general, respondents from Sweden and younger (60-64 years) were less affected by the complaints than those from other countries (e.g. Germany) and older (e.g. 70-74 years), respectively. Respondents on medication (e.g. pain killers) were less affected by all pain complaints and those with high social support by pain in joints or limbs. High scores on anxiety and depression and having many diseases increased the likelihood of being affect by all pain complaints. CONCLUSIONS Abuse was related with certain pain complaints (e.g. headache), but other factors and in particular mental health and physical diseases impacted on all pain complaints. Medication and partly social support had a positive effect on the pain experience, i.e. the complaints interfered less with for instance the daily-life of the respondents.
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Affiliation(s)
- Kersti Danell Stén
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Mindaugas Stankūnas
- Department of Health Management, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Maria Gabriella Melchiorre
- Scientific Technological Area, Socio Economic Research Centre, Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy
| | - Gloria Macassa
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto, Medical School, Porto, Portugal
| | - Jutta Lindert
- Department of Public Health Science, Protestant University of Applied Sciences, Ludwigsburg, Germany
| | - Francisco Torres-Gonzalez
- Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain
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Vilpert S, Ruedin HJ, Trueb L, Monod-Zorzi S, Yersin B, Büla C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital. BMC Health Serv Res 2013; 13:344. [PMID: 24011089 PMCID: PMC3846121 DOI: 10.1186/1472-6963-13-344] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 08/30/2013] [Indexed: 12/04/2022] Open
Abstract
Background Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65–84 years during this period and to investigate the evolution of these comparisons over time. Methods Data considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated. Results Between 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65–84 years. Compared to patients aged 65–84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010. Conclusions Oldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.
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Affiliation(s)
- Sarah Vilpert
- Swiss Health Observatory, Espace de l'Europe 10, CH-2010 Neuchâtel, Switzerland.
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Terndrup TE, Ali S, Hulse S, Shaffer M, Lloyd T. Multimedia education increases elder knowledge of emergency department care. West J Emerg Med 2013; 14:132-6. [PMID: 23599848 PMCID: PMC3628460 DOI: 10.5811/westjem.2012.11.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 09/17/2012] [Accepted: 11/21/2012] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Elders who utilize the emergency department (ED) may have little prospective knowledge of appropriate expectations during an ED encounter. Improving elder orientation to ED expectations is important for satisfaction and health education. The purpose of this study was to evaluate a multi-media education intervention as a method for informing independently living elders about ED care. The program delivered messages categorically as, the number of tests, providers, decisions and disposition decision making. METHODS Interventional trial of representative elders over 59 years of age comparing pre and post multimedia program exposure. A brief (0.3 hour) video that chronicled the key events after a hypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED health care providers, and 2 professional actors for the patient and spouse. Pre- and post-video tests results were obtained with audience response technology (ART) assessed learning using a 4 point Likert scale. RESULTS Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signed-rank tests). The following four learning objectives showed significant improvements: number of tests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50 (0.00, 1.00)]; number of providers expected 1.0 (1.00, 1.50); communications 1.0 (1.00, 1.50); and pre-hospital medical treatment 0.50 (0.00, 1.00). Elders (96%) judged the intervention as improving their ability to cope with an ED encounter. CONCLUSION A short video with graphic side-bar information is an effective educational strategy to improve elder understanding of expectations during a hypothetical ED encounter following calling 911.
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Affiliation(s)
- Thomas E Terndrup
- Penn State College of Medicine, Department of Emergency Medicine, Hershey, Pennsylvania
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