Potentially preventable visits to the emergency department in older adults: Results from a national survey in Italy

Older patients represent between 12% and 21% of the emergency department (ED) visits and this percentage is expected to increase in the coming decades [1], growing up to about 34% by 2030 [2]. Italian data indicate that older adults already exceed 30% of ED users [3,4]. Older adults have more serious illnesses than other age group on arrival in the ED, as measured by triage acuity, diagnostic work-up, and hospital admission rate, and are also more likely to try to contact their general practitioner or other non-urgent sources of medical care prior to arriving at the ED [5]. Despite this, over 20% of ED attendances are potentially preventable [6], with an increased risk of adverse consequences such as re-admission, hospitalization, mortality [7]. Several studies focused on the potentially preventable ED visit patterns by older adults, but only a few are population-based [5], and many studies are based on administrative data. The hospital administrative data provided a very limited insight other than medical diagnoses, considering that older people attend the ED for a range of reasons that are individual, societal and related to the health services system, as well as strictly clinical [8]. The absence of data on the source population precludes the evaluation of the role of risk factors such as environmental factors or other socio-structural constructs [5]. The aim of our study was to identify socio-demographic characteristics and health care resources use of population-based cohort of community-dwelling older adults admitted to the ED for a potentially preventable visit.Design Data come from the Multipurpose Survey “Health conditions and use of health services”, edition 2012–2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households. Subject 50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered. Methods Potentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed. Results In the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75–84 years: OR 1.096, CI 1.001–1.199; 85+years: OR 1.022, CI 1.071–1.391), at least one hospital admission (OR 3.869, IC 3.547–4.221), to waive a visit (OR 1.188, CI 1.017–1.389) or an exam (OR 1.300, CI 1.077–1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819–0.975), area of residence (Center: OR 0.850; CI 0.766–0.943; Islands: OR 0.617, CI 0.539–0.706, South: OR 0.560; CI 0.505–0.622), private paid assistance (OR 0.761, CI 0.602–0.962); a better health-related quality of life (PCS score 46–54: OR 0.744, CI 0.659–0.841; PCS score >55: OR 0.746, CI 0.644–0.865).