title: Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study.
abstract: BACKGROUND
  Unmet need to perform activities of daily living (ADL) is associated with increased use of urgent health services by the elderly. However, the reported associations may be confounded by psychological distress. We examine the independent effects of unmet need and psychological distress upon emergency department (ED) visits.
  
  
  METHODS
  We conducted a prospective study of randomly selected community-dwelling adults aged ≥ 75. We report here the results for women only (n = 530). In-person interviews collected data on self-reported unmet need and the 14-item l'Indice de détresse psychologique de Santé Québec psychological distress scale. ED visits were identified from an administrative database. Multivariable logistic regression was used to identify predictors of any ED visit in the 6 months following the baseline interview.
  
  
  RESULTS
  In multivariable analysis, unmet need in instrumental ADL was associated with subsequent ED visits (odds ratio = 1.57, 95% confidence interval = 1.02-2.41), as was psychological distress (odds rate = 1.30, 95% confidence interval = 1.02-1.67). The magnitude of the association between unmet need and ED visits was overestimated in statistical models that did not adjust for psychological distress.
  
  
  CONCLUSIONS
  Both unmet need and psychological distress were independent predictors of ED visits. Future investigations of unmet need and health services utilization should include psychological distress to control for confounding and improve the internal validity of statistical models.
authors.affiliation: Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. jacqueline.quail@gmail.com
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Quail
authors.forename: Christina
authors.initials: C
authors.lastname: Wolfson
authors.forename: Abby
authors.initials: A
authors.lastname: Lippman
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015999:Multivariate Analysis; D020380:Needs Assessment; D011446:Prospective Studies; D012111:Residence Characteristics; D013315:Stress, Psychological