Predictors of repeat emergency department visits among patients aged over 65 years

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Published Dec 25, 2017
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Vol. 95 No. 5 (2017): Issue May 2017

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Hanen Ghazali
Rania Jebri
Anware Yahmadi
Najla El Heni
Ines Chermiti
Sami Souissi

Abstract


Background: The objective of our study was to evaluate the predictors of repeat visits at Emergency Department (ED) in patients aged ≥ 65 years.
Methods: A prospective observational study was conducted over a month. Inclusion:  patients (age> = 65 year) seen in the ED and leaving the same day. The epidemiological and clinical characteristics at the first visit (index visit (IV)) were collected. The Identification of Senior At Risk (ISAR) score was used to assess our patients. The number of visits (n ≥ 2) to ED within 30 days of the IV was estimated by a phone contact.
Results: Inclusion of125 patients. Mean age = 76 +/- 7 years. The sex ratio was 0.85. Twenty five percent of our patients made repeat visits the following period. Univariate analysis identified: age> 75 years, mean ISAR score>2, history of renal failure, ED visit a month prior to the IV, hospitalization in the last 6 months, patients who depend on someone else help at home and those taking more than 3 medications daily. In multivariate analysis, ED visit a month prior to the IV, hospitalization in the last 6 months, and patients who depend on someone else help at home were independent factors of repeat visits to the ED.
Conclusion:  Efforts to identify patients at high risk of repeat visits to the ED should be made.

Keywords:

Emergency department, elderly, repeat visits, ISAR

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References

  1. Dickes-Sotty H, Chevalet P, Fix MH, Riaudel T, Serre-Sahel C, Ould-Aoudia V, Berrut G, De Decker L. Six-months outcomes after admission in acute geriatric care unit secondary to a fall. Geriatr Psychol Neuropsychiatr Vieil 2012;10:391-401.
  2. Wolinsky FD, Liu L, Miller TR, An H, Geweke JF, Kaskie B, et al. Emergency Department Utilization Patterns Among Older Adults. J Gerontol A BiolSci Med Sci 2008;63:204-9.
  3. John W., Steven B. et al. Older Americans 2012: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC June 2012.
  4. McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool. Journal of the American Geriatrics Society1999 ;47:1229-37.
  5. McCusker J, Cardin S, Bellavance F, Belzile É. Return to the Emergency Department among Elders: Patterns And Predictors. Academic Emergency Medicine 2000;):249-59.
  6. Hwang U, Shah MN, Han JH, and al. Transforming emergency care for older adults. Health Aff (Millwood) 2013;32:2116-21.
  7. Asomaning N, Loftus C. and al. Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan do study act model and validation results. J Emerg Nurs 2014;40:357-64.
  8. McCusker J, Bellavance F, Cardin S, Belzile E, Verdon J. Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit. Ann Emerg Med 2000; 36: 438-45.
  9. Salvi F, Morichi V, Grilli A and al. Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging 2012; 16: 313-8.
  10. Di Bari M, Salvi F, Roberts AT and al. Prognostic stratification of elderly patients in the emergency department: a comparison between the ‘Identification of Seniors at Risk' and the ‘Silver Code'. J Gerontol A BiolSci Med Sci 2012; 67: 544-50.
  11. Deschodt M, Wellens NIH, Braes T and al. Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin ExpRes 2011; 23: 421-6.
  12. Buurman BM, van den Berg W, Korevaar JC, MilisenK,deHaan RJ, de Rooij SE. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.Eur J Emerg Med 2011; 18:215-20.
  13. Braes T, Moons P, Lipkens P et al. Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging ClinExper Res 2010; 22: 345-51.
  14. Yim VWT, Rainer TH, Graham CA, Woo J, Lan FL, Ting SM. Emergency department intervention for high-risk elders: identification strategy and randomised controlled trial to reduce hospitalisation and institutionalisation. Hong Kong Med J 2011; 13(Suppl. 3): 4-7.
  15. Lowenstein SR, Crescenzi CA, Kern, DC, Steel K. Care of the elderly in the emergency department. Ann Emerg Med 1986; 15:528-35.
  16. McCuskel J, Healey E, Bellavance F, Connolly B. Predictors of Repeat Emergency Department Visits by Elders. Bnerg.Med. 1997; 4581 -588.
  17. Penninx B, Van Tiburg T, Kriegsman D, Deep D, Boeke A, Van Eijk J. Effects of social support and personal coping resources on mortality in older age: The Longitudinal Aging Study Amsterdam. Am J Epidemiol 1997; 146:510-9.
  18. Boult C, Dowd B, McCaffrey D, Boult L, Hernandez R, Krulewitch H. Screening elders for risk of hospital admission. J Am GeriatrSoc 1993; 41:811 -7.
  19. Suffoletto B; Miller T; Shah R; Callaway C; Yealy DM. Predicting Older Adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool Emerg Med J 2016;33(1):49.
  20. Graf CE, Giannelli SV, Herrmann FR, and al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department: comparison of two screening tools. Swiss Med Wkly 2012;141;w13327.
  21. Carpenter CR, Shelton E, Fowler S, et al. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta analysis. Acad Emerg Med 2015;22:1-21.
  22. Bissett M, Cusick A, Lannin NA. Functional assessments utilized in emergency departments: a systematic review. Age Ageing 2013;42:163-72.
  23. Wilkins P, Beckett M. Audit of unexpected return visits to an accident and emergency department. Arch Emerg Med 1992; 9:352-6.
  24. Brookoff D, Minniti-Hill M. Emergency department-based home care. Ann Emerg Med 1994; 23:1101-6.
  25. Cameron S, Keil J, Rajacich D, Dunham K. Using functional health patterns to predict outcome with seniors. Can Nurse. 1996; Nov:34-8.
  26. Rising KL, White LF, Fernandez WG, and al. Emergency department visits after hospital discharge: a missing part of the equation. Ann Emerg Med 2013;62:145-50.
  27. Vashi AA, Fox JP, Carr BG, and al. Use of hospital based acute care among patients recently discharged from the hospital. JAMA 2013;309:364-71.