title: Unmet Need for Help With Activities of Daily Living Disabilities and Emergency Department Admissions Among Older Medicare Recipients.
abstract: This study determined whether self-reports of unmet need for help with activities of daily living (ADL) disabilities are prognostic of emergency department (ED) utilization.
  
  
  
  This prospective cohort study of 2,194 community-living, ADL-disabled subjects combined 2004 National Long-Term Care Survey responses with linked Medicare data through 2005. A negative binomial count model was computed to assess the association between unmet ADL need and number of subsequent ED admissions while statistically adjusting for predisposing, enabling, and need characteristics associated with ED admissions among older adults.
  
  
  
  The adjusted annual incidence rate (IR) for ED admissions was 19% higher for unmet versus met need (IR = 1.19; 95% confidence interval [CI] = 1.00-1.40; p = .047). The IR for ED admissions for falls and injuries was higher for those with unmet ADL versus met ADL need (IR = 1.43; 95% CI = 1.10-1.86), and trended toward significance for ED admissions for skin breakdown (IR = 2.02; 95% CI = 0.97-2.88), but was not significant for ED admissions for dehydration (IR = 1.13; 95% CI= 0.79-1.63).
  
  
  
  Unmet ADL need is prognostic of ED admissions, especially for falls and injuries. Future research is needed to determine whether resolution of unmet ADL need reduces ED utilization.
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Zach
authors.initials: Z
authors.lastname: Hass
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Glen
authors.initials: G
authors.lastname: DePalma
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Craig
authors.affiliation: Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis.
authors.forename: Huiping
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Human Development, Virginia Tech, Blacksburg.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Sands
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003153:Community Health Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D020380:Needs Assessment; D011446:Prospective Studies; D014481:United States
keywords: Disabilities; Home and Community based care and services; Medicaid/Medicare