Study identifies patterns of ED use among geriatric patients

Geriatric patients with frequent emergency department (ED) use are more likely to have comorbidities, be admitted or transferred, and visit three or more hospitals in a year than less frequent ED users, a recently published study in the Annals of Emergency Medicine found.

The purpose of the study was to evaluate patterns of ED use among the geriatric population in order to inform healthcare delivery both in and out of the ED for that population. The study looked at ED visits of patients older than 65 in the state of California during a one-year period. The researchers used a statewide database of 326 licensed, nonfederal, general, acute care hospitals in California and found that in 2014, 1,259,809 patients over 65 accounted for 2,792,219 total ED visits.

The researchers defined “frequent users” as those having between six and 20 ED visits in one year, with “super users” defined as having more than 20 ED visits. The analysis found that 70,300 geriatric patients (5.6%) in in the frequent user category accounted for 556,477 of all ED visits (19.9%) for that population, and the 1,149 super users (0.1%) had a total of 35,930 ED visits (1.3%).

The study also looked at patient characteristics to identify patterns in ED use. There were more female patients (57.8%) than male patients, and the majority of patients were non-Hispanic whites (61.3%). This distribution of demographics was minimally different between less frequent and frequent ED users. Additionally, Medicare was the primary expected payer for 86.3% of patients.

However, there were significant differences in diagnoses and utilization patterns between less frequent and frequent users. Less frequent users were less likely to have been admitted or transferred than frequent users (44.6% vs. 85.8%) and were less likely to discontinue care (1.7% vs. 7.8%).

Frequent users had more comorbidities than less frequent users. The most common disease classifications included in the comorbidity index score (according to primary and secondary diagnoses) were diabetes without complications (25.8%), chronic pulmonary disease (21.5%), renal disease (19.1%), congestive heart failure (16%), and peripheral vascular disease (15.1%).

Finally, the study found that 20% of frequent users visited three or more hospitals in the one-year period. Though the study did not capture other primary care and specialty services, the study authors expect use of those services to be higher among the geriatric population and suggest that targeting health interventions across the care continuum both within the ED and beyond should be explored as the geriatric population continues to increase.