title: Assessing the impact older people from care homes place on the emergency services.
abstract: OBJECTIVE
  The increasing size of our older population will provide more pressure to UK emergency services. Studies show that older people are more likely to be admitted from the emergency department (ED). This study aimed to evaluate the impact care home (CH) patients have on the ED within a large urban UK city and whether end-of-life planning and alternative pathways can improve quality of care for these patients.
  
  
  METHODS
  Data were collected for 11760 patients of over 65 years of age. CH and non-care home patients attending the ED were compared and an in-depth analysis of the sickest patients was carried out.
  
  
  RESULTS
  CH patients were more likely to arrive by ambulance, odds ratio (OR) of 8.09 [95% confidence interval (CI) 6.17-10.6; P<0.001]; have an investigation, OR of 1.51 (95% CI: 1.28-1.77; P<0.001); present with a medical condition or fall, OR of 2.05 (95% CI: 1.75-2.40; P<0.001); to spend more than 4 h in the ED, OR of 1.48 (95% CI: 1.30-1.69; P<0.001); to be admitted, OR of 1.32 (95% CI: 1.16-1.50; P<0.001). Of the sickest CH patients admitted (n=73), 63.9% (46 of 72) died within 24 h of admission, 8.3% (6 of 72) had a postmortem, 90.4% (66/73) had a 'do not attempt resuscitation' order after admission. Most, however, had investigations and treatments: venous blood (60 of 73), arterial blood gases (38 of 73), X-rays (48 of 73), intravenous fluids (52 of 73), and intravenous antibiotics (24 of 73).
  
  
  CONCLUSIONS
  This reflects the demand that CH patients place on emergency services compared with non-care home patients. The results also highlight the importance of end-of-life decisions before ED attendance. Further work is required to identify alternative pathways to improve the quality of care and reduce the impact on secondary care.
authors: School of Health and Related Research, University of Sheffield, Sheffield Teaching Hospitals NHS Trust, Regent Court, 30 Regent Street, Sheffield, South Yorkshire, UK. c.frangoulakis@doctors.org.uk
authors: Constantine
authors: C
authors: Girio-Fragkoulakis
authors: Claire
authors: C
authors: Gardner
authors: Susan
authors: S
authors: Cross
authors: Suzanne
authors: S
authors: Mason
authors: Stephen
authors: S
authors: Walters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data; D006707:Homes for the Aged; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D006113:United Kingdom; D014505:Urban Population