title: Emergency department visits in older people: pattern of use, contributing factors, geographical differences and outcomes.
abstract: OBJECTIVE
  To assess the pattern of use of Emergency Departments (EDs), factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or more living in the Italian Lombardy Region in 2012.
  
  
  METHODS
  Based on an administrative database the study population was divided into groups according to the number of ED visits. A multinomial logistic regression model was performed to compare the characteristics of each group. The Getis-Ord's G statistic was used to evaluate the clusters of high and low visit prevalence odd ratios (OR) at district level. To estimate the severity of the disease leading to ED attendance, visits were stratified based on the level of emergency and outcome.
  
  
  RESULTS
  About 2 million older people were included in the analyses: 78 % had no ED visit, 15 % only 1, 7 % 2 or more. Male sex, age 85 years or more, high number of drugs, ED visits and hospital admissions in the previous year and the location of an ED within 10 km from the patient's place were all factors associated with a higher risk to have more ED visits. Clusters of high and low prevalence of visits were found for occasional users. Overall, 83 % of ED visit with a low emergency triage code at admission had as visit outcome discharge at home.
  
  
  CONCLUSIONS
  In older people several variables were associated with an increased risk to have a high number of ED visits. Most of the visits were done for non-urgent problems and significant geographic differences were observed for occasional users.
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy. carlotta.franchi@marionegri.it.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cartabia
authors.affiliation: Scientific Direction, IRCCS-Maggiore Hospital Foundation, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Santalucia
authors.affiliation: Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Baviera
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS-Maggiore Hospital Foundation, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Fortino
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Bortolotti
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.affiliation: Emergency Division, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Monzani
authors.affiliation: Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Clavenna
authors.affiliation: Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Roncaglioni
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000368:Aged; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D062211:Spatio-Temporal Analysis; D014218:Triage / Q000706:statistics & numerical data
keywords: Emergency departments; Older people; Outcomes; Spatial autocorrelation; Triage code