A biopsychosocial profile of the geriatric population who frequently visit the emergency department.

Abstract

Over the last two decades the emergency department has become the primary source of health care for a large segment of the population. While this practice is discouraged by ED staff and primary care providers, it is an unfortunate reality. Recent literature has examined the use of the ED from many different angles. Areas investigated include various demographics (age, sex, race, etc.), method of payment, presenting complaint, and availability of primary care. Repeated inappropriate use of ED services by individuals (the so called "frequent fliers") has also attracted attention. The interest in this sub-population of patients is presumably due to the prevalence as well as the excessive costs of this behavior. In the present study a retrospective chart review was used to establish the biopsychosocial profiles of geriatric patients identified as being frequently seen in the emergency department for non-urgent conditions. Even though only 11% of the US population is age 65 or older, the elderly in America consume 30% of the health care resources, and in the next 20 years that figure is expected to climb to 50% (1). Demographics, ED presentation, diagnosis, and treatment as well as past medical history were collected. The objectives of the study were to identify these elderly frequent fliers and determine what could be the reasons behind the inappropriate use of emergency department resources by these patients. The average age of the sample was 74. The marital status of the sample was as follows: 42.4% widowed, 27.2% married, 15% divorced, and 18.5% single. Over half (52.6%) of those patients were brought to the ED by ambulance. The most common presenting complaint was chest pain (20.8%), followed by somatic complaints (18.9%), GI (16.1%), dyspnea (13.7%), and change in mental status (12.8%). The most prevalent ED diagnosis was psychiatric (18.4%) in nature. The other diagnoses were somatic (16.6%), GI (11.8%), and pulmonary (10.9%). 88.5% of the sample reported to have a primary care physician. However, 45% of the ED visits occurred between 9 AM and 5 PM at a time when a physician should have been available. The admission rate for this sample was 21.9%, which is half what has been found in the "normal" elderly, as reported by McDonald and Abrahams.