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Keywords:

  • aging;
  • elderly;
  • emergency services;
  • geriatric care;
  • health services research;
  • emergency department;
  • utilization

Abstract

  1. Top of page
  2. Abstract
  3. References

Abstract. Objective: Tb compare the use of emergency medical care by elders in the United States in 1995 with that previously described for 1990.

Methods: A computerized billing database of 88 EDs in 21 states was retrospectively reviewed for 1995, comparing elder and nonelder patients, estimating national use of emergency medical services by elders, and comparing the 1995 data with previously published results for 1990.

Results: From 1990 to 1995, the number of ED visits in the United States increased from 92 million to 100 million. The number of visits made by patients aged 65 years or older increased from 13,639,400 (15%) to 15,666,300 (15.7%), but this increase did not reach statistical significance (p = 0.17). The admission rate for elder ED patients increased from 32% to 46% over the five-year interval (p < 0.01). This represents more than 7 million hospital admissions for elder patients in 1995. The rate of intensive care unit (ICU) admission for elders decreased from 7% to 6% over the five-year interval (p = 0.56), compared with 1.3% for nonelder patients for both years. Thirty percent of elder ED patients arrived by ambulance in 1990, compared with 33% in 1995 (p = 0.02). Based on 1995 data, elders comprised 39% of patients arriving by ambulance [odds ratio (OR) 4.75, 95% confidence interval (CI) = 4.71 to 4.79], 43% of all admissions (OR 6.59, 95% CI = 6.54 to 6.64), and 47% of ICU admissions (OR 5.00, 95% CI = 4.91 to 5.09). The comparable ORs in 1990 were 4.4, 5.6, and 5.5, respectively.

Conclusions: From 1990 to 1995, the overall number of ED visits increased. The rate of increase was somewhat greater for elder patients. The use of ambulance services also disproportionately grew among elder patients, as did the rate of hospital admission. The overall rate of ICU admission was stable, but actually fell modestly for elder patients. Of these changes, only the increase in the rate of hospital admission for elders reached statistical significance.

References

  1. Top of page
  2. Abstract
  3. References
  • 1
    U.S Senate Special Committee on Aging: Aging America: Trends and Projections. Washington , DC : U.S. Department of Health and Human Services, 1988.
  • 2
    Schneider EL, Geralmik JM. The aging of America. JAMA 1990; 263: 233540.
  • 3
    Eliastam M.. Elderly patients in the emergency department. Ann Emerg Med 1989; 18: 12229.
  • 4
    Strange GR, Chen EH, Sanders AB. Use of emergency departments by elderly patients: projections from a multi-center database. Ann Emerg Med 1992; 21: 81924.
  • 5
    Singal BM, Hedges JR, Rousseau ES, et al. Geriatric patient emergency visits, part 1:comparison of visits by geriatric and younger patients. Ann Emerg Med 1992; 21: 8027.
  • 6
    Baum SA, Rubenstein LZ. Old people in the emergency room: age related differences in emergency department use and care. J Am Geriatr Soc 1987; 35: 628.
  • 7
    Lowenstein SR, Crescenzi CA, Kern DC, Steel K.. Care of the elderly in the ED. Ann Emerg Med 1986; 15: 52835.
  • 8
    Weingarten MS, Wainwright ST, Saccheti AD. Trauma and aging: effects on hospital costs and length of stay. Ann Emerg Med 1988; 17: 103.
  • 9
    Levy PS, Lemeshow S.. Sampling for Health Professionals. Belmont , CA : Wadsworth, 1980.
  • 10
    Rosner B.. Fundamentals of Biostatistics, 4th ed. Belmont , CA : Wadsworth, 1995.
  • 11
    McCloskey AH, Woolwich J., Holahon D.. Reforming the Health Care System: State Profiles 1995. Washington , DC : Public Policy Institute, American Association of Retired Persons, 1995.
  • 12
    American Hospital Association Hospital Statistics: Emerging Trends in Hospitals. Chicago : AHA, 199697.
  • 13
    Ettinger WH, Casani JA, Coon PJ, Muller DC, Piazza-Ap-pel K.. Patterns of use of the emergency department by elderly patients. J Gerontol 1987; 42: 63842.
  • 14
    Wofford JL, Schwartz E., Timerding BL, Folmar S., Ellis SC, Messick CH. Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med 1996; 3: 6949.
  • 15
    Stussman BJ. National Hospital Ambulatory Medical Care Survey: 1993 emergency department summary. Advance Data 271. Hyattsville , MD : National Center for Health Statistics, 2.
  • 16
    Stussman BJ. National Hospital Ambulatory Medical Care Survey: 1994 emergency department summary. Advance Data 275. Hyattsville , MD : National Center for Health Statistics, 1996.
  • 17
    Jollis JG, Ancukiewicz M., DeLong ER, et al. Discordance of databases designed for claims payment versus clinical information systems: implications for outcomes research. Ann Intern Med 1993; 119: 84450.