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Related Experiment Videos

Return to the emergency department among elders: patterns and predictors.

J McCusker1, S Cardin, F Bellavance

  • 1Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, McGill University, Montreal, Quebec, Canada. jane.mccusker@smhc.qc.ca

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|March 24, 2000
PubMed
Summary

Elderly patients frequently return to the emergency department (ED) within 30 days of discharge. A new screening tool, Identification of Seniors At Risk (ISAR), effectively predicts these return visits.

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Area of Science:

  • Geriatric Medicine
  • Emergency Medicine
  • Public Health

Background:

  • High rates of emergency department (ED) utilization among elders pose a significant healthcare burden.
  • Understanding patterns and predictors of return visits is crucial for improving care and resource allocation for older adults.

Purpose of the Study:

  • To characterize the pattern of emergency department (ED) return visits in elders within six months of an initial visit.
  • To identify predictors associated with early (within 30 days) and frequent (three or more visits in six months) return visits.
  • To assess the efficacy of the Identification of Seniors At Risk (ISAR) screening tool in predicting ED return visits.

Main Methods:

  • A cohort of 1,122 patients aged 65 years and older, discharged from four Canadian EDs, was studied over six months.

Related Experiment Videos

  • Data collected at the index visit included a 27-item questionnaire covering social, physical, and mental risk factors, medical history, and service utilization. The ISAR scale comprised six of these questions.
  • Return visits and diagnoses were abstracted from hospital utilization databases.

    • Main Results:

    • Over 43% of patients made at least one return visit, with 19.3% returning within 30 days and 7.5% making frequent returns.
    • Early return visits were more likely to be for the same diagnosis as the index visit.
    • Logistic regression identified prior hospitalization, depressive symptoms, and specific diagnoses as predictors for both early and frequent returns. History of heart disease, marital status, and alcohol consumption predicted early returns, while diabetes history, recent ED use, and lack of social support predicted frequent returns.

    Conclusions:

    • Return visit rates are highest in the first month post-ED discharge, often for the same condition.
    • Both medical and social determinants significantly predict early and frequent ED returns in the elderly population.
    • The ISAR screening tool demonstrates utility in identifying older adults at increased risk for ED return visits, aiding in targeted interventions.