Chary Anita, Bhananker Annika, Suh Michelle, Leavitt David, Brickhouse Elise, Tamma Shreya, Ramirez Jose, Rios Mariana, Naik Aanand D, Samuels-Kalow Margaret, George Naomi
Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
J Am Geriatr Soc. 2025 Sep;73(9):2808-2818. doi: 10.1111/jgs.19616. Epub 2025 Jul 30.
The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).
We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use.
Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chronic disease whose management bordered between outpatient and inpatient settings; (5) had a sentinel event (e.g., fall, surgery) with cascading sequelae; (6) faced recurrent challenges managing indwelling catheters, tubes, and long-term vascular access.
Among socioeconomically disadvantaged older adults in our sample, medical complexity was a more salient driver of frequent ED use than unmet social needs. Innovations to strengthen outpatient care and offer alternatives to ED and hospital admission are needed for this population.
急诊科是社会经济弱势老年人的医疗安全网和常见就医点。对于社会经济弱势的老年急诊患者对自身健康、医疗服务可及性及急诊科使用情况的看法，我们知之甚少。此类见解可为针对未满足的临床及健康相关社会需求（HRSN）的定制干预措施提供指导。
我们在一家公立安全网医院的急诊科对老年人进行了一项定性研究。我们采访了过去一年中急诊就诊≥4次的60岁及以上患者。半结构化访谈探讨了感知到的健康需求以及急诊就诊的潜在动机。我们使用经过验证的测量方法筛查HRSN。我们进行了内容分析，以根据安德森的医疗服务使用行为模型评估急诊使用的关键驱动因素，并运用叙事分析原则来识别频繁使用急诊科的老年患者的不同特征。
在68名访谈参与者中，40%为黑人，43%为西班牙裔。60%的人有医疗保险。大多数参与者（63%）报告了HRSN，但很少将其描述为急诊使用的主要驱动因素。相反，门诊医疗服务可及性差以及与特定病情需求相关的医疗复杂性是最突出的因素。出现了六种不同特征的患者：（1）缺乏保险和初级保健；（2）面临急性病症；（3）对严重基础疾病存在急性担忧；（4）患有慢性病，其管理介于门诊和住院环境之间；（5）发生了具有连锁后遗症的哨兵事件（如跌倒、手术）；（6）在管理留置导管、引流管和长期血管通路方面面临反复挑战。
在我们样本中的社会经济弱势老年人中，医疗复杂性比未满足的社会需求更显著地驱动了频繁的急诊使用。需要进行创新以加强门诊医疗服务，并为该人群提供急诊科和住院治疗的替代方案。
