Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults

Abstract Background Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.

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Emergency Department Utilization Patterns Among Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/63.2.204 ◽

2008 ◽

Vol 63 (2) ◽

pp. 204-209 ◽

Cited By ~ 38

Author(s):

F. D. Wolinsky ◽

L. Liu ◽

T. R. Miller ◽

H. An ◽

J. F. Geweke ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Emergency Department Utilization ◽

Utilization Patterns

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The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

Global Advances in Health and Medicine ◽

10.1177/2164956120985479 ◽

2021 ◽

Vol 10 ◽

pp. 216495612098547

Author(s):

Jennifer Perloff ◽

Cindy Parks Thomas ◽

Eric Macklin ◽

Peggy Gagnon ◽

Timothy Tsai ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Low Income ◽

Tai Chi ◽

Statistical Significance ◽

Emergency Department Visits ◽

Care Utilization ◽

P Value ◽

Senior Housing ◽

The Impact

Background/Objectives This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. Design Cluster randomized controlled trial with randomization at the housing site level. Setting Greater Boston, Massachusetts. Participants The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. Intervention Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. Results The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. Conclusion ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

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End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118824962 ◽

2019 ◽

Vol 36 (6) ◽

pp. 507-512 ◽

Cited By ~ 2

Author(s):

Meredith MacKenzie Greenle ◽

Karen B. Hirschman ◽

Ken Coburn ◽

Sherry Marcantonio ◽

Alexandra L. Hanlon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

End Of Life ◽

Emergency Department Visit ◽

Chronically Ill ◽

Care Utilization ◽

Utilization Patterns ◽

Over Time

Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.

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Abstract P267: Burden of Disease Among Older Adults With Type 1 and Type 2 Diabetes: Results From the Study of Longevity in Diabetes (SOLID)

Circulation ◽

10.1161/circ.141.suppl_1.p267 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Mary E Lacy ◽

Paola Gilsanz ◽

Chloe Eng ◽

Michal S Beeri ◽

Andrew J Karter ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Emergency Department ◽

Functional Impairment ◽

Coronary Bypass ◽

Emergency Department Utilization ◽

Geriatric Syndromes ◽

History Of

Introduction: Increasing incidence of type 1 diabetes (T1D) coupled with increasing life expectancy have resulted in an unprecedented number of older adults living with T1D. However, little is known about the burden of aging and diabetes-related complications in this unique group. We hypothesized that older adults with T1D would have greater diabetes and aging-related burden compared to an age, sex, race/ethnicity, and education-matched group of older adults with type 2 diabetes (T2D). Methods: We compared the following characteristics by diabetes type among older adults (aged ≥60) with T1D (n=805) and T2D (n=249) from the Study of Longevity in Diabetes (SOLID) using chi-squared tests: diabetes history (age of onset, diabetes duration); diabetes-related complications (retinopathy, neuropathy, nephropathy, severe hypo- and hyperglycemia resulting in hospitalization/emergency department utilization), cardiovascular disease (stroke, MI, coronary bypass), and geriatric syndromes (depression, incontinence, memory problems and functional impairment). Results: Average age at diagnosis and duration of diabetes, respectively, were 28 years old and 40 years duration for T1D and 56 years old and 13 years duration for T2D (Table 1). Compared to T2D, participants with T1D were more likely to report history of retinopathy, neuropathy, nephropathy, lifetime hypo- and hyperglycemic events resulting in hospitalization/emergency department utilization, and history of a coronary bypass. By contrast, those with T2D were more likely to be incontinent and have functional impairment. Conclusions: Our results show that diabetes-related complications are more prevalent in those with T1D than in comparable adults with T2D, while certain geriatric syndromes were more prevalent in those with T2D. Older adults with T1D are a growing population with unique diabetes-specific and aging-related considerations. Additional research is needed to understand the interplay of aging and diabetes in this group to inform patient care .

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FAMILY CAREGIVER FACTORS AND SUBSEQUENT EMERGENCY DEPARTMENT UTILIZATION AMONG OLDER ADULTS WITH DISABILITY

Innovation in Aging ◽

10.1093/geroni/igz038.802 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S219-S219

Author(s):

Julia Burgdorf ◽

John Mulcahy ◽

Halima Amjad ◽

Judith D Kasper ◽

Kenneth Covinsky ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Status ◽

Family Caregivers ◽

Family Caregiver ◽

Primary Caregiver ◽

Emergency Department Utilization ◽

Community Living ◽

Physical Strain

Abstract Community-living older adults with disability are frequent Emergency Department (ED) users and most rely on family caregiver support. However, no prior research has examined associations between caregiver characteristics and subsequent ED utilization among older adults. We draw on a sample of 2,521 community-living older adults with mobility/self-care disability and their primary family caregivers to identify caregiver characteristics associated with all-cause or potentially preventable ED use. We use Cox proportional hazards regression to separately model the likelihood of all-cause and potentially preventable ED use as a function of caregiver characteristics. Models account for competing risk of mortality and adjust for measures of older adults’ socio-demographic characteristics, health status, and survey wave. About half (52.5%) of older adults incurred 1+ ED visit and 26.8% incurred 1+ potentially preventable ED visit within 12 months of interview. Adjusting for survey wave and older adult sociodemographic characteristics and health status, older adults were at greater risk of all-cause ED use if their primary caregiver provided greater than 40 hours of care per week (HR: 1.22, 95% CI: 1.04-1.43; p=0.02), helped with health care tasks (HR: 1.26; 95% CI: 1.08-1.46; p<0.01), or experienced physical strain (HR: 1.18; 95% CI: 1.03-1.36; p=0.02). Older adults were at greater risk of potentially preventable ED use if their primary caregiver helped with health care tasks (HR: 1.25; 95% CI: 1.02-1.54; p=0.03). Findings highlight the relevance of caregiver factors to older adults’ ED use and suggest the need for assessment and support of family caregivers in the care delivery setting.

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PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3151 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S857-S857

Author(s):

Elizabeth A Jacobs ◽

Rebecca Schwei ◽

Scott Hetzel ◽

Jane Mahoney ◽

KyungMann Kim

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Peer Support ◽

Peer Group ◽

Peer To Peer ◽

Emergency Department Visits ◽

Urgent Care ◽

Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 > years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

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MP34: Elder abuse in the emergency department: a systematic scoping review

CJEM ◽

10.1017/cem.2019.169 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S54-S55

Author(s):

E. Mercier ◽

A. Nadeau ◽

A. Brousseau ◽

M. Emond ◽

J. Lowthian ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Physical Abuse ◽

Health Care Providers ◽

Scoping Review ◽

Elder Abuse ◽

Community Dwelling ◽

Screening Tools ◽

Care Providers

Introduction: This systematic scoping review aims to synthetize the available evidence on the epidemiology, risk factors, clinical characteristics, screening tools, prevention strategies, interventions and knowledge of health care providers regarding elder abuse in the emergency department (ED). Methods: A systematic literature search was performed using three databases (Medline, Embase and Cochrane Library). Grey literature was scrutinized. Studies were considered eligible when they were observational studies or randomized control trials reporting on elder abuse in the prehospital and/or ED setting. Data extraction was performed independently by two researchers and a qualitative approach was used to synthetize the findings. Results: A total of 443 citations were retrieved from which 58 studies published between 1988 and 2018 were finally included. Prevalence of elder abuse following an ED visit varied between 0.01% and 0.03%. Reporting of elder abuse to proper law authorities by ED physicians varied between 2% to 50% of suspected cases. The most common reported type of elder abuse detected was neglect followed by physical abuse. Female gender was the most consistent factor associated with elder abuse. Cognitive impairment, behavioral problems and psychiatric disorder of the patient or the caregiver were also associated with physical abuse and neglect as well as more frequent ED consultations. Several screening tools have been proposed, but ED-based validation is lacking. Literature on prehospital- or ED-initiated prevention and interventions was scarce without any controlled trial. Health care providers were poorly trained to detect and care for older adults who are suspected of being a victim of elder abuse. Conclusion: Elder abuse in the ED is an understudied topic. It remains underrecognized and underreported with ED prevalence rates lower than those in community-dwelling older adults. Health care providers reported lacking appropriate training and knowledge with regards to elder abuse. Dedicated ED studies are required.

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