Background: Older adults are estimated to make over 20 million visits to the emergency department (ED) annually. Reducing unnecessary ED use is a priority, and designing appropriate interventions requires a nuanced understanding of what is driving health care utilization. Previous studies have established that sociodemographic and clinical health factors contribute to frequent ED use, but less is known about the importance of enabling resources as defined by the Aday-Andersen Health Behavior Model.
Goal: The purpose of our project is to identify enabling resources among older adult emergency department users.
Objectives: In light of a recent National Academy of Medicine report recommending population segmentation to better understand the specific needs in high-need subgroups, we examine the enabling resources among high-need segments of the ED population.
Approach: This is a retrospective cross-sectional study of patient-survey data collected as part of an on-going randomized trial. We defined high-need segments as individuals reporting one or more functional limitation with an activity of daily living and/or multimorbidity (3+ chronic conditions). For purposes of comparison, we use “relatively healthy” subjects who did not report a functional limitation or multimorbidity. 434 adults 60 and older living in Monroe County, New York or Dane County, Wisconsin who consented to participate in a randomized trial and were enrolled into the control group.
Results: One out of four older adults (24.9%) reported living with multimorbidity and a functional limitation; 32.5% reported living with multimorbidity and no functional limitations; and, 9% reported a functional limitation and fewer than three chronic conditions. Older adults with functional limitations and/or multimorbidity were more likely to report fair/poor health compared to relatively healthy older adults (p<0.001). We also found substantial differences in enabling resources by high-need segment. Older adults reporting a functional limitation with and without multimorbidity were more than three times as likely to report poor health literacy compared to relatively healthy older adults (p=0.015) and more than four times likely to report high levels of social isolation (p<0.001).
Importance to public health: Older adults with high needs have fewer enabling resources. These high-need older adults may require tailored interventions to reduce repeat ED visits, and future unnecessary ED visits.