芬兰高龄老人急诊科就诊的频率及预测因素：活力90+研究
Frequency and predictors of emergency department visits among the oldest old in Finland: the Vitality 90+ Study.
作者信息
Abraham Sherin Billy, Pulkki Jutta, Aaltonen Mari, Jämsen Esa, Raitanen Jani, Enroth Linda
机构信息
Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.
Unit of Services (Older People Services), Finnish Institute for Health and Welfare, Helsinki, Finland.
出版信息
BMC Health Serv Res. 2025 Jun 5;25(1):807. doi: 10.1186/s12913-025-12923-2.
BACKGROUND
Emergency department (ED) visits increase with age. However, knowledge about the frequency and drivers of ED visits among the oldest old (90 years and above) is scarce, and neither is it known whether patterns differ between those living at home and in round-the-clock care. As understanding of ED use and the factors influencing ED visits is crucial for the functioning of health care systems, this study examined the frequency and predictors of ED visits in a 90+ population living at home and in round-the-clock care.
METHODS
Data from the Vitality 90+ survey, a population-based study with 1561 respondents in 2014 in Tampere, Finland, was combined with national register data on ED use and mortality until the end of 2017. Predictors of the first ED visit were examined using Cox regression models (4-year cumulative hazard) and the frequency and predictors of 1–3 and ≥ 4 ED visits in one year of follow-up with multinomial logistic regression models.
RESULTS
Over the four-year study period, 79% of the participants had at least one ED visit. Those living at home had higher cumulative hazards of ED visits and were more often frequent ED users (≥ 4 ED visits) than those living in round-the-clock care. Not receiving home care, multimorbidity, poor subjective health and wellbeing, and limitations in functioning increased the risk of ED visits among home dwellers, while having dementia, limitations in functioning, impaired sensory functions, and less frequent social contacts decreased the risk among round-the-clock care residents. In both groups, the predictors of ED visits were similar in one- and four-year follow-ups.
CONCLUSIONS
The frequency and predictors of ED visits greatly differ between those living at home and in round-the-clock care. Since most ED visits occurred among those living at home and having poor health but not receiving formal home care, improving the continuity of care and the coverage of home care services could help to curb the increase in ED visits among the fast-growing oldest old population.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s12913-025-12923-2.
背景
急诊科就诊次数随年龄增长而增加。然而，关于高龄老人（90岁及以上）急诊科就诊频率及驱动因素的了解甚少，且居家老人和全天候护理机构中的老人就诊模式是否存在差异也尚不明确。由于了解急诊科利用情况及影响急诊科就诊的因素对于医疗保健系统的运作至关重要，本研究调查了居家及接受全天候护理的90岁及以上人群的急诊科就诊频率和预测因素。
方法
将2014年在芬兰坦佩雷进行的一项基于人群的活力90+调查数据（1561名受访者）与截至2017年底的国家急诊科利用和死亡率登记数据相结合。使用Cox回归模型（4年累积风险）检查首次急诊科就诊的预测因素，并使用多项逻辑回归模型检查随访1年中1 - 3次及≥4次急诊科就诊的频率和预测因素。
结果
在为期四年的研究期间，79%的参与者至少有一次急诊科就诊。与住在全天候护理机构中的老人相比，居家老人急诊科就诊的累积风险更高，且更常成为频繁就诊者（≥4次急诊科就诊）。未接受家庭护理、患有多种疾病、主观健康和幸福感较差以及功能受限会增加居家老人急诊科就诊的风险，而患有痴呆症及功能受限、感觉功能受损和社交接触较少则会降低全天候护理机构居民的就诊风险。在两组中，1年和4年随访中急诊科就诊的预测因素相似。
结论
居家老人和全天候护理机构中的老人在急诊科就诊频率和预测因素方面存在很大差异。由于大多数急诊科就诊发生在居家且健康状况不佳但未接受正规家庭护理的人群中，改善护理连续性和家庭护理服务覆盖范围有助于遏制快速增长的高龄老人群体中急诊科就诊人数的增加。
补充信息
在线版本包含可在10.1186/s12913-025-12923-2获取的补充材料。
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