Elderly Use of ED Rising
A report published in the Annals of Emergency Medicine notes the increasing use of the emergency room by the elderly. The team sought to determine reasons for use of the ED, noting that this is the first step required to minimize utilization.
A team from George Washington University examined data collected with the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 through 2003. The set was limited to those patients age 65 and older. Using census data, the team calculated visit rates per 100 persons for each year.
Over the ten years of data that was reviewed, ED utilization among the elderly increased 34 percent. The highest increase, with respect to rate, was among African American patients. The increase among this sub-group was 90 percent, reaching 77 visits to the ED per 100 persons annually. Among white patients, utilization increased to 35 visits per 100 persons annually, a 26 percent jump.
The team also considered the diagnosis or complaint that compelled the visit. Four categories were derived: acute non-injury, exacerbation of chronic condition, injury, and a catch-all “other” category. Over 90 percent of the increased use was attributed to the other classification.
Interestingly, the rise in ED utilization was not associated with an increase in the number of hospital admissions. Nevertheless, these findings may help explain some of the current crowding noted in emergency rooms across the country. More elderly patients seeking care in this setting may be a function of decreased primary care utilization because of the high costs. More and more patients are foregoing routine care or not taking medications correctly because of financial constraints.
This use of the emergency room is expected to continue to rise, according to the analysis published. The team projects that by 2013, the number of trips to the emergency room for patients between ages 65 and 74 could double.