scholarly journals Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019318 ◽  
Author(s):  
Joyce J H Wachelder ◽  
Isabelle van Drunen ◽  
Patricia M Stassen ◽  
Steffie H A Brouns ◽  
Suze L E Lambooij ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Socioeconomic Status ◽  
Older Adult ◽  
Community Dwelling ◽  
Low Ses ◽  
Inhospital Mortality ◽  
Average Household Income ◽  
Return Visits ◽  
Triage Level

ObjectivesOlder adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.DesignA retrospective study.ParticipantsOlder adults (≥65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low (<€1800/month), intermediate (€1800–€2300/month) and high (>€2300/month).Primary outcomesHospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.ResultsIn total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).ConclusionIn older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.

scholarly journals Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Rai-Fu Chen ◽  
Kuei-Chen Cheng ◽  
Yu-Yin Lin ◽  
I-Chiu Chang ◽  
Cheng-Han Tsai
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Insurance ◽  
Chronic Illness ◽  
Length Of Stay ◽  
Prediction Model ◽  
Older Adult ◽  
National Health Insurance ◽  
Research Database ◽  
Return Visits

BACKGROUND Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. OBJECTIVE This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. METHODS We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. RESULTS The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. CONCLUSIONS Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

scholarly journals Socioeconomic Status, Frailty, and All-Cause Mortality in Korean Older Adults: A 3-Year Population-Based Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jinkyung Cho ◽  
Inhwan Lee ◽  
Soo Hyun Park ◽  
Youngyun Jin ◽  
Donghyun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Low Ses ◽  
Increased Risk ◽  
All Cause Mortality

Background. Little is known regarding the effects of socioeconomic status (SES) and frailty on mortality in Korea. Objective. This study investigated the combined impact of low SES and frailty on all-cause mortality in Korean older adults. Methods. Study sample at baseline comprised 7,960 community-dwelling adults (56.8% women) aged 65 years and older. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of low SES and frailty for all-cause mortality. Results. Overall, low SES plus frailty resulted in an increased risk of all-cause mortality (HR = 1.56, 95% CI = 1.09–2.23, P=0.015) even after adjustments for all the measured covariates, as compared with high SES plus nonfrailty (HR = 1). Among older adults aged 65–75 years, the increased mortality risk of either low SES plus nonfrailty (HR = 1.37, 95% CI = 1.02–1.84, P=0.038) or high SES plus frailty (HR = 2.09, 95% CI = 1.12–3.91, P=0.021) remained significant even after adjustments for all the covariates, as compared with high SES plus nonfrailty (HR = 1). Conclusion. The current findings suggest that either low SES or frailty is significantly associated with increased all-cause mortality in Korean older adults.

scholarly journals Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study

10.2196/22491 ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. e22491
Author(s):  
Rai-Fu Chen ◽  
Kuei-Chen Cheng ◽  
Yu-Yin Lin ◽  
I-Chiu Chang ◽  
Cheng-Han Tsai
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Insurance ◽  
Chronic Illness ◽  
Length Of Stay ◽  
Prediction Model ◽  
Older Adult ◽  
National Health Insurance ◽  
Research Database ◽  
Return Visits

Background Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. Objective This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. Methods We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. Results The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. Conclusions Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

scholarly journals Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

2021 ◽  
pp. 089826432199332
Author(s):  
Wanda Rietkerk ◽  
Jannet de Jonge-de Haan ◽  
Joris P. J. Slaets ◽  
Sytse U. Zuidema ◽  
Debby L. Gerritsen
Keyword(s):  
Older Adults ◽  
Behavior Change ◽  
Older Adult ◽  
Goal Setting ◽  
Geriatric Assessment ◽  
Well Being ◽  
Community Dwelling ◽  
Implementation Processes ◽  
Adult Involvement ◽  
Community Dwelling Older Adults

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.

scholarly journals 94 Association between Dual-Task Timed “UP and GO” Test and Occurrence of Falls According to Age Group (Young-Older or Old-Older Adults): A Longitudinal Observation Study

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Tsuyoshi Asai ◽  
Kensuke Oshima ◽  
Yoshihiro Fukumoto ◽  
Shogo Misu
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Dual Task ◽  
Community Dwelling ◽  
Age Group ◽  
Adult Group ◽  
Observation Study ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

Abstract Aim To elucidate the association between the occurrence of falls and timed “up and go” (TUG) test score in a dual-task condition among community-dwelling older adults by age group. Methods This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG test (single-TUG) and a TUG test while counting aloud backward from 100 (dual-TUG) were conducted at baseline. The dual-task cost (DTC) value was computed from these results. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. At follow-up, 322 participants had dropped out and six participants had missing data for falls. The final analysis included 658 individuals (follow-up rate: 658/987, 67%) divided into a young-older adult group (aged 60–74 years) and an old-older adult group (aged 75 years or older). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models. Results For old-older adults, there were significant associations between the occurrence of falls and DTC value (odds ratio [OR] 0.981, 95% confidence interval [CI]: 0.963–0.999, p = 0.040) and single-TUG score (OR 1.129, 95% CI: 1.006–1.268, p = 0.039). However, no significant associations were observed for young-older adults. Conclusions Slower single-TUG test score and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual task assessment is useful for predicting falls in TUG fall assessment for old-older adults.

Association between childhood socioeconomic status and subjective memory complaints among older adults: results from the Japan Gerontological Evaluation Study 2010

2019 ◽  
Vol 31 (12) ◽  
pp. 1699-1707 ◽  
Author(s):  
Toshinori Nishizawa ◽  
Ayako Morita ◽  
Takeo Fujiwara ◽  
Katsunori Kondo
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Evaluation Study ◽  
Community Dwelling ◽  
Self Report ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Memory Complaints ◽  
Childhood Socioeconomic Status ◽  
Community Dwelling Older Adults

ABSTRACTBackground:Subjective memory complaints (SMC) have been suggested as an early marker of mild cognitive impairment and dementia. However, there is a paucity of evidence on the effects of early life conditions on the development of SMC in old age. This study is aimed at investigating the association between childhood socioeconomic status (SES) and SMC in community-dwelling older adults.Methods:We used the data of the Japan Gerontological Evaluation Study, a population-based cohort study of people aged 65 years or older enrolled from 28 municipalities across Japan. Childhood SES and SMC in everyday life were assessed from the self-report questionnaire administered in 2010 (n = 16,184). Poisson regression was performed to determine their association, adjusted for potential confounders and life-course mediators and examined cohort effects.Results:We identified SMC in 47.4% of the participants. After adjusting for sex, age, and number of siblings, low and middle childhood SES were associated with 29% (prevalence ratio [PR]: 1.29, 95% confidence interval [CI]: 1.22, 1.36) and 10% higher prevalence of SMC (PR: 1.10, 95%CI: 1.04, 1.17), respectively, compared with high childhood SES (p for trend <.001). The interaction terms between childhood SES and age groups were not statistically significant.Conclusion:Childhood SES is significantly associated with SMC among community-dwelling older adults. Efforts to minimize childhood poverty may diminish or delay the onset of SMC and dementia in later life.

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