Personality traits predict emergency department utilization over 3 years in older patients.
BACKGROUND
Emergency department (ED) utilization by older patients has major implications for morbidity, mortality, and health costs, yet its behavioral determinants remain poorly understood. Powerfully tied to health in older adults, the "Big Five" personality traits of neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness may predict ED use.


OBJECTIVE
Investigate the role of personality in prospective ED use among older patients.


METHODS
Prospective cohort.


METHODS
Adults aged 65 and older.


METHODS
Participants completed the NEO Five Factor Inventory of personality at baseline, and interviewers administered the Cornell Services Index assessing ED use at baseline and 3 yearly follow-ups.


RESULTS
Controlling for income, education, gender, age, physician-assessed medical burden and physical functioning, and interviewer-assessed impairments in basic activities of daily living and physical self-maintenance, and depression, lower agreeableness and higher extroversion were each associated with increased odds of an ED visit over the follow-up period. A 1 sample deviation (SD) increase in extroversion (i.e., 50th versus 83rd population percentile) increased the odds of ED use by 51% (adjusted odds ratio [AOR] [95% CI] = 1.51 [1.03-2.21], z = 2.12, N = 923, p = 0.034). A 1-SD decrease in agreeableness (i.e., 50th versus 17th population percentile) increased odds of ED use by 54% (AOR [95% CI] = 1.54 [1.05-2.22], z = -2.25, N = 923, p = 0.034).


CONCLUSIONS
The greater assertiveness and social confidence signified by lower agreeableness and higher extroversion may help older adults overcome potential barriers to the ED. Overly introverted and agreeable older adults may require special encouragement to access the ED--particularly for time--sensitive conditions--to reduce morbidity and mortality.
Chapman
Benjamin P
BP
Departments of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA. Ben_Chapman@URMC.Rochester.edu
Shah
Manish
M
Friedman
Bruce
B
Drayer
Rebecca
R
Duberstein
Paul R
PR
Lyness
Jeffrey M
JM
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006785:Hospitals, University; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D009518:New York; D010551:Personality; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors