Emergency Department Use by Centenarians

The 2008 Nationwide Emergency Department Sample

Matthew R. Carey; Embry M. Howell, PhD; Megan Colleen McHugh, PhD

Disclosures

Prev Chronic Dis. 2013;10 

In This Article

Abstract and Introduction

Abstract

Introduction Older adults have higher rates of emergency department use than do younger adults, and the number of centenarians is expected to increase. The objective of this study was to examine centenarians' use of the emergency department in the United States, including diagnoses, charges, and disposition.

Methods The 2008 Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality provided encounter-level data on emergency department visits and weights for producing nationwide estimates. From this data set, we collected patient characteristics including age, sex, primary diagnosis, and disposition. We used χ2 tests and t tests to test for significant differences among people aged 80 to 89, 90 to 99, and 100 years or older.

Results Centenarians had a lower rate of emergency department use than those aged 90 to 99 (736 per 1,000 vs 950 per 1,000; P < .05). We found no significant difference in use between centenarians and those aged 80 to 89. The most common diagnoses for centenarians were superficial injuries (5.8% of visits), pneumonia (5.1%), and urinary tract infections (5.1%). Centenarians were more likely to visit the emergency department for fall-related injuries (21.5%) than those aged 80 to 89 (14.1%; P < .05) and 90 to 99 (18.7%; P < .05). Centenarians were more likely to die in the emergency department (2.0%) than were those aged 80 to 89 (0.6%; P < .05) and 90 to 99 (0.7%; P < .05).

Conclusion Centenarians in emergency departments in the United States have different diagnoses, conditions, and outcomes than other older Americans.

Introduction

The number of centenarians in the United States is projected to increase more than 700% during the coming decades, from 79,000 in 2008 to more than 600,000 in 2050.[1] Although in absolute terms these increases are small, they indicate that this minority group may one day strongly influence health policy. This growth has led to research on the health outcomes of these eldest members of society.[2–10] Studies have noted the unique health care needs and use patterns of centenarians compared with other older populations. Many centenarians, for instance, have been able to delay or avoid chronic conditions commonly associated with old age such as heart disease and stroke.[8] Centenarians also have lower instances of cancer.[9,10] Despite this body of literature on centenarians and many studies on emergency department use by older adults in general, there is little research on emergency department use by centenarians.[11–13]

Understanding the patterns of use and etiology of emergency department visits among centenarians is important for several reasons. First, emergency physician and nurse training can use this information to tailor services to the needs of this population, which will represent a greater share of visits in the future. Second, hospital administrators can use this information for capacity planning, which is crucial to the problem of crowding in emergency departments nationwide.[14] This problem may be exacerbated by the growing number of centenarians who may be more likely to be admitted to the hospital. Third, this information may be used to develop targeted services to prevent emergency department visits by centenarians. Understanding why centenarians visit the emergency department will also allow health care administrators to determine the appropriateness of such visits and design programs that could address the primary causes of emergency department use among this group, thereby reducing the number of visits and slowing the rise of health care costs. The objective of this study was to describe centenarians' use of emergency department services, including rates of use, primary diagnoses, charges, and disposition.

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