Factors associated with re-presentation to emergency departments in elderly people with pain

To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain.

We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital's rapid response, assessment and care planning program for elderly people.

Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P=0.003); (2) the presence of Home and Community Care Services (P=0.03); and (3) the absence of a gait aid (P=0.019). Nineteen per cent of eligible patients re-presented to ED within 30 days of initial presentation.

These findings contribute to current debate about opioid prescription and effective pain management in the elderly. The study highlights the need for routine follow-up care of older people discharged from the ED with pain, particularly those discharged home with opioids or with complex care needs.