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Emergency Department Utilization Patterns Among Older Adults

¹ The Iowa City VA Medical Center, Iowa.
² The University of Iowa, Iowa City.
³ Texas A&M University Health Science Center, College Station.

Address correspondence to Fredric D. Wolinsky, PhD, the University of Iowa, 200 Hawkins Drive, E-205 General Hospital, Iowa City, IA 52242. E-mail: fredric-wolinsky{at}uiowa.edu

Background. We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

Methods. A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283–99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

Results. The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

Conclusions. Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

Key Words: Emergency department • Utilization patterns • Medicare, Claims data