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Analysis

Target and Manage Frequent Geriatric Utilizers of Your Emergency Room

By Christopher Cheney  
   August 12, 2019

More emergency departments are helping to manage the care of medically complex older adults.

Among older adults, frequent utilizers of the emergency department tend to have multiple comorbidities, pain-related diagnoses, and injury-related visits, new research found.

Older adults are associated with high ED costs and resource consumption. Compared to other patients, older adults use the ED at higher rates, have long ED stays, and need more medical interventions during their visit.

The new research published in Annals of Emergency Medicine found that frequent geriatric utilizers of the ED accounted for an out-sized portion of visits. While frequent geriatric utilizers represented 5.7% of the patients in the study, they accounted for 21.2% of all ED visits.

"Although the ED is often portrayed as a significant and costly portion of [healthcare] spending, much of this is attributed to the increasing trend of community-based providers relying on EDs to evaluate patients with complex disease who were previously admitted to the hospital, as evidenced by an increase in high-intensity ED visits. As a result, the ED's role in delivering care for a large proportion of the population is expanding, especially for older and sicker patients," the researchers wrote.

There were three primary predictors of frequent geriatric ED utilization:

1. Multiple comorbidities: Patients over 65 with three or more comorbidities had the highest odds of frequent ED use (odds ratio 7.2).

2. Pain: The second most likely factor for frequent geriatric ED utilization was primary diagnosis of pain (5.5 odds ratio).

3. Injury: The geriatric ED frequency odds ratio for an injury-related visit was 3.8.

"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," the researchers wrote.

Managing frequent geriatric ED users
 

Among geriatric patients, identifying factors that can lead to frequent ED visits and providing supportive services are crucial to improving care and lowering costs, the lead author of the Annals of Emergency Medicine research told HealthLeaders.

"EDs are increasingly playing a pivotal role in the care of these patients. EDs throughout the United States have started to develop and implement geriatric-specific policies and protocols. These include comprehensive health risk screening, consultations with specialists such as geriatricians and pharmacists while patients are in the ED, referrals to memory clinics and other specialty clinics when a need is identified, and redesigning patient care areas to meet the needs of older patients," said Edward Castillo, PhD, MPH, Department of Emergency Medicine, University of California, San Diego.

Designing health programs across the continuum of care can be effective in managing older patients who are frequent ER users, he said.

"Intervention programs across the continuum of care would allow providers more opportunities to implement prevention strategies or treatment plans that can help alleviate the need for frequent ED visits and hospitalizations in older patients," Castillo said.

Older patients often have complex medical conditions that require care after they leave the ED, he said. "Wraparound services in the primary care, ED, and post-ED setting that take into consideration the patients' and their caregiver's wellbeing are necessary to successfully manage these patients."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

In new research, a small portion of older adult patients—5.7% of the total—accounted for 21.2% of all ED visits.

Multiple comorbidities were the primary predictor of frequent geriatric utilization of the ED.

Designing health programs across the care continuum can effectively manage older patients who tend to be frequent ER users.


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