National Institute of Health and Science on Ageing (IRCCS INRCA), Ancona, Italy.
Italian National Institute of Statistics (Istat), Via Cesare Balbo 16, Rome, Italy.
Aging Clin Exp Res. 2021 Mar;33(3):659-668. doi: 10.1007/s40520-020-01571-7. Epub 2020 May 2.
Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level.
We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched by spatial dimensions. The outcomes were analysed using t-tests and ANOVA, while OLS and multilevel regressions have been used to identify independent correlates of ED visit rates.
Mean ED visit rate was 56.3% and 25.3% among older people and the rest of the population (< 75 years), respectively. The multivariate analysis for older people showed that the presence of an ED within the municipality and living alone were positively associated with ED use, whereas greater availability of nursing homes was negatively associated. For general population (< 75 years), distance to closest ED, economic deprivation and bigger hospitals were negatively associated with ED visits.
Our study shows that interventions to reduce frequent ED use by older people should include the availability of long-term care facilities in the area. As population ageing is progressing, our results suggest that investing in alternative care options for older people with long-term care needs might have the beneficial impact of reducing the overall ED rates and improving quality and appropriateness of care.
许多研究调查了与老年人过度使用急诊部（ED）相关的因素。然而，几乎没有证据表明更好地获得长期护理服务如何影响 ED 就诊率。因此，我们在市级层面估计了 ED 使用与背景（距离最近的 ED 最近的距离）、需求（入院时的优先级水平和护理剥夺）、倾向（社会经济状况）和使能因素（卫生服务的可用性）之间的关联。
我们通过比较意大利中 Marche 地区 233 个市和 13 个卫生区的 75 岁及以上的老年人口与 75 岁以下的人口，调查了 ED 就诊率。行政数据通过空间维度进行了充实。使用 t 检验和方差分析对结果进行了分析，而 OLS 和多水平回归则用于确定 ED 就诊率的独立相关因素。
老年人的平均 ED 就诊率为 56.3%，其余人群（<75 岁）为 25.3%。老年人的多变量分析显示，市辖区内有 ED 和独居与 ED 使用呈正相关，而养老院的可用性较高则呈负相关。对于一般人群（<75 岁），距离最近的 ED、经济剥夺和更大的医院与 ED 就诊呈负相关。
我们的研究表明，减少老年人频繁使用 ED 的干预措施应包括在该地区提供长期护理设施。随着人口老龄化的推进，我们的结果表明，为有长期护理需求的老年人投资替代护理选择可能会产生减少整体 ED 率、提高护理质量和适当性的有益影响。
