Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003

Study objective: In 2005, the Centers for Disease Control and Prevention reported increasing emergency department (ED) visit rates per 100 people. The greatest increase in visit rate was among individuals 65 years and older. Given that older ED visitors have longer lengths of stay in the ED, are more likely to be admitted, and compose a growing proportion of the American population, this finding could have a significant negative effect on ED crowding. The first step toward addressing this issue is a better understanding of the nature of these visits. Methods: We performed trend analysis for persons aged 65 years and older using 1993 to 2003 National Hospital Ambulatory Medical Care Survey data, an annual national sample of visits to the EDs of nonfederal general and short-stay hospitals. SAS 9.1 computed population estimates and standard errors for number of ED visits. Annual census data were used to compute visit rates per 100 persons. A least-squares test for trend determined slopes and 95% confidence intervals. Results: Visits for patients aged 65 to 74 years increased 34% during the study period. The visit rate for blacks increased 93% to 77 visits per 100 population, whereas the rate for whites increased 26% to 36 visits per 100. The admission rate did not change significantly during the study period. The number of visits at which 3 or more medications were prescribed increased 44%. The increased visits occurred primarily in the category of "other and undefined" diagnoses (90% increase). Conclusion: If these trends continue, ED visits in the United States for the 65- to 74-year-old group could nearly double from 6.4 million visits to 11.7 million visits by 2013.