School of Nursing, Department of Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Geriatr Gerontol Int. 2020 Apr;20(4):317-323. doi: 10.1111/ggi.13875. Epub 2020 Feb 3.
To identify factors associated with frequent emergency department (ED) use among older adults with ambulatory care sensitive conditions.
This was a retrospective cohort study using databases from the Régie de l'assurance maladie du Québec. We included community-dwelling individuals aged ≥65 years in the Province of Quebec (Canada), who consulted in ED at least once between 2012 and 2013 (index period), and were diagnosed with at least one ambulatory care sensitive condition in the 2 years preceding and including the index date (n = 264 473). We used a multivariate logistic regression model to evaluate the association between independent variables and being a frequent geriatric ED user, defined as four or more visits during the year after the index date.
Out of the total study population, 17 332 (6.6%) individuals were considered frequent ED users in the year after the index date, accounting for 38% of ED uses for this period. The main variables associated with frequent geriatric ED use were older age, presence of chronic obstructive pulmonary disorder or diabetes, higher comorbidity index, common mental health disorders, polypharmacy, higher number of past ED and specialist visits, rural residence, and higher material and social deprivation. Dementia was inversely associated with frequent ED use.
Frequent geriatric ED users constitute a complex population whose characteristics need to be managed thoroughly in order to enhance the quality and efficiency of their care. Further studies should address their description in administrative databases so as to combine self-perceived and professionally evaluated variables. Geriatr Gerontol Int 2020; 20: 317-323.
确定与有门诊医疗敏感条件的老年人经常使用急诊室（ED）相关的因素。
这是一项使用魁北克省健康保险局数据库的回顾性队列研究。我们纳入了魁北克省（加拿大）年龄≥65 岁的社区居住者，他们在 2012 年至 2013 年期间至少在 ED 就诊过一次（索引期），并且在索引日期之前和包括索引日期在内的 2 年内至少被诊断出一种门诊医疗敏感疾病（n=264473）。我们使用多变量逻辑回归模型来评估独立变量与作为频繁老年 ED 用户的关联，定义为在索引日期后的一年中就诊四次或以上。
在总研究人群中，17332 人（6.6%）在索引日期后的一年中被认为是频繁 ED 用户，占该时期 ED 使用的 38%。与频繁老年 ED 使用相关的主要变量是年龄较大、存在慢性阻塞性肺疾病或糖尿病、更高的合并症指数、常见精神健康障碍、多种药物治疗、过去 ED 和专科就诊次数更多、农村居住和更高的物质和社会剥夺。痴呆症与频繁 ED 使用呈负相关。
频繁的老年 ED 用户构成了一个复杂的人群，其特征需要彻底管理，以提高其护理的质量和效率。进一步的研究应该在管理数据库中描述他们的情况，以便将自我感知和专业评估的变量结合起来。老年医学杂志 2020; 20: 317-323.
