Factors Associated With Geriatric Frequent Users of Emergency Departments

Study objective: Frequent users of the emergency department (ED) are often associated with increased health care costs. Limited research is devoted to frequent ED use within the increasing senior population, which accounts for the highest use of health care resources. We evaluate patient characteristics and patterns of ED use among geriatric patients. Methods: This was a multicenter, retrospective, longitudinal, cohort study of ED visits among geriatric patients older than 65 years in 2013 and 2014. Logistic regression analysis was used to identify independent associations with frequent users. The setting was a nonpublic statewide database in California, which includes 326 licensed nonfederal hospitals. We included all geriatric patients within the database who were older than 65 years and had an ED visit in 2014, for a total of 1,259,809 patients with 2,792,219 total ED visits. The main outcome was frequent users, defined as having greater than or equal to 6 ED visits in a 1-year period, starting from their last visit in 2014. Results: Overall, 5.7% of geriatric patients (n=71,449) were identified as frequent users of the ED. They accounted for 21.2% (n=592,407) of all ED visits. The associations of frequent ED use with the largest magnitude were patients with an injury-related visit (odds ratio 3.8; 95% confidence interval 3.8 to 3.9), primary diagnosis of pain (odds ratio 5.5; 95% confidence interval 5.4 to 5.6), and comorbidity index score greater than or equal to 3 (odds ratio 7.2; 95% confidence interval 7.0 to 7.5). Conclusion: Geriatric frequent users are likely to have comorbid conditions and be treated for conditions related to pain and injuries. These findings provide evidence to guide future interventions to address these needs that could potentially decrease frequent ED use among geriatric patients. Copyright (C) 2018 by the American College of Emergency Physicians.