Target Your ER's Frequent Flyer Geriatric Patients

Predictors of frequent geriatric users of the emergency department indicate that a multidisciplinary approach to care is required.

In geriatric patient populations, predictors of high emergency department utilization include specific diagnoses such as chronic pulmonary disease and multiple comorbidities, recent research shows.

The country's burgeoning number of seniors account for about 15% of the population but they contribute to more than 21% of total healthcare expenditures. Relative to younger Americans, seniors use emergency rooms more, have longer stays in the ED, and utilize more resources and interventions in the ED.

The research findings, published recently in Annals of Emergency Medicine, indicate that interventions should be tailored for seniors who are frequent users of the ED, the researchers wrote.

"Programs designed to meet the needs of geriatric patients across the continuum of care may be helpful to address the unique needs of geriatric patients to maintain physical and mental health. This may be especially important in care venues outside of the ED and inpatient setting."

The research features data collected from more than 1.2 million geriatric patients. Frequent users of the ED were defined as patients who visited an ER six or more times over the course of a year.

• 5.6% of the geriatric patients qualified as frequent users
   
• The frequent users accounted for 19.9% of visits to an ED
   
• The most common comorbidities were diabetes without complications (25.8%), chronic pulmonary disease (21.5%), renal disease (19.1%), congestive heart failure (16%), and peripheral vascular disease (15.1%)
   
• The strongest predictors of high ED utilization were pain-related diagnoses, injury-related visits, and high numbers of comorbidities

"Overall, we found vulnerable patients with likely complex medical, psychosocial, and functional issues associated with increased utilization patterns," the researchers wrote.

Reducing geriatric frequent users of the emergency department

The findings suggest possible interventions to improve care for seniors who are frequent ER users, the lead author of the research, Edward Castillo, PhD, MPH, told HealthLeaders.

"Geriatric frequent users are different than other frequent user populations, so interventions need to be designed for this specific population. To be successful, these interventions will likely need to have a multidisciplinary staff that can identify senior-specific needs through screenings, coordinate appropriate care and resources for the patient when they leave the ED, and follow up to be sure their needs are being met," he said. 

Postacute care is part of the solution, said Castillo, who is an associate adjunct professor in the Department of Emergency Medicine at the University of California, San Diego. "Once appropriate needs are identified, outpatient and home health services can be used to avoid ED visits and hospital admissions for some conditions and some patients."