Advanced

Ecological factors associated with Emergency Department use by older people in Italy

Barbabella, Francesco ; Balducci, Francesco ; Chiatti, Carlos LU ; Cherubini, Antonio and Salvi, Fabio (2021) In Aging clinical and experimental research 33(3). p.659-668
Abstract

Background: Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level. Methods: We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched... (More)

Background: Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level. Methods: We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched by spatial dimensions. The outcomes were analysed using t-tests and ANOVA, while OLS and multilevel regressions have been used to identify independent correlates of ED visit rates. Results: Mean ED visit rate was 56.3% and 25.3% among older people and the rest of the population (< 75 years), respectively. The multivariate analysis for older people showed that the presence of an ED within the municipality and living alone were positively associated with ED use, whereas greater availability of nursing homes was negatively associated. For general population (< 75 years), distance to closest ED, economic deprivation and bigger hospitals were negatively associated with ED visits. Conclusions: Our study shows that interventions to reduce frequent ED use by older people should include the availability of long-term care facilities in the area. As population ageing is progressing, our results suggest that investing in alternative care options for older people with long-term care needs might have the beneficial impact of reducing the overall ED rates and improving quality and appropriateness of care.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Emergency Department (ED) use, GIS, Health geography, Healthcare services, Nursing homes, Socioeconomic factors, Spatial analysis
in
Aging clinical and experimental research
volume
33
issue
3
pages
659 - 668
publisher
Kurtis
external identifiers
  • scopus:85085125468
  • pmid:32358732
ISSN
1594-0667
DOI
10.1007/s40520-020-01571-7
language
English
LU publication?
yes
id
61d85feb-e3c6-4460-aac9-df44d93427d9
date added to LUP
2020-06-15 13:31:12
date last changed
2021-05-11 04:41:18
@article{61d85feb-e3c6-4460-aac9-df44d93427d9,
  abstract     = {<p>Background: Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level. Methods: We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched by spatial dimensions. The outcomes were analysed using t-tests and ANOVA, while OLS and multilevel regressions have been used to identify independent correlates of ED visit rates. Results: Mean ED visit rate was 56.3% and 25.3% among older people and the rest of the population (&lt; 75 years), respectively. The multivariate analysis for older people showed that the presence of an ED within the municipality and living alone were positively associated with ED use, whereas greater availability of nursing homes was negatively associated. For general population (&lt; 75 years), distance to closest ED, economic deprivation and bigger hospitals were negatively associated with ED visits. Conclusions: Our study shows that interventions to reduce frequent ED use by older people should include the availability of long-term care facilities in the area. As population ageing is progressing, our results suggest that investing in alternative care options for older people with long-term care needs might have the beneficial impact of reducing the overall ED rates and improving quality and appropriateness of care.</p>},
  author       = {Barbabella, Francesco and Balducci, Francesco and Chiatti, Carlos and Cherubini, Antonio and Salvi, Fabio},
  issn         = {1594-0667},
  language     = {eng},
  number       = {3},
  pages        = {659--668},
  publisher    = {Kurtis},
  series       = {Aging clinical and experimental research},
  title        = {Ecological factors associated with Emergency Department use by older people in Italy},
  url          = {http://dx.doi.org/10.1007/s40520-020-01571-7},
  doi          = {10.1007/s40520-020-01571-7},
  volume       = {33},
  year         = {2021},
}