Repeat attendance by older people at accident and emergency departments

Background. Older people are an increasing user group at accident and emergency departments and often have complex needs over and above the clinical cause of attendance. Few studies to date appear to have focused specifically on older people's re-attendance at such departments following direct discharge. However, these few studies conclude that incomplete staff assessment of older people's needs in this setting may play a part in reasons for re-attendance and recommend that further research is needed in this area. Aims. The aim of this paper is to describe a 6-month study exploring re-attendance, assessment and discharge issues for people aged over 75 years at an accident and emergency department. Methods. Documentary research was primarily used to collate data. Interviews with specialist health care professionals were also used to cross-check recorded documentary details of interest and to gain a wider perspective. In addition, illustrative cases were developed (incorporating a broader range of hospital documentation) to exemplify key issues raised relating to re-attendance by older people at the accident and emergency department concerned. Findings. Professional practice related to assessment of older people's social and functional needs was inconsistent in this accident and emergency department and some staff clearly underestimated the impact of illness or injury when considering their ability to cope on discharge. An illustrative case summary is included to highlight that such issues may be significant factors in re-attendance. Conclusion. Improving practice in relation to social and functional assessment and raising staff awareness concerning older people's potential needs seem important in accident and emergency departments. With little research identified to date into re-attendance, further research on this issue is recommended.