ABSTRACT
BACKGROUND:
To determine if
elderly frequent attenders are associated with increased 30-day
mortality, assess
resource utilization by the
elderly frequent attenders and identify associated characteristics that contribute to
mortality.
METHODS:
Retrospective
observational study of
electronic clinical records of all
emergency department (ED) visits over a 10-year period to an urban tertiary
general hospital in
Singapore.
Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day
mortality, admission rate, admission
diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and
Student t-test was used to assess continuous variables on their
association with being a frequent attender. Univariate and multivariate
logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day
mortality), to determine factor independent
odds ratios of being a frequent attender.
RESULTS:
1.381 million attendance
records were analyzed.
Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking
at 10.2% in the sixth visit. Factors associated with
mortality include
patients with
neoplasms,
ambulance utilization,
male gender and having attended the ED the previous year.
CONCLUSION:
Elderly attenders have a higher 30-day
mortality risk compared to the overall ED
population, with
mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to
address frequent ED visits by the
elderly, especially in an
aging society.