title: The ED as the primary source of hospital admission for older (but not younger) adults.
abstract: BACKGROUND
  The elderly population in the United States is growing. This age shift has important implications for emergency departments (EDs), which currently account for more than 50% of inpatient hospitalizations. Our objective was to compare the percentage of inpatient admissions starting in the ED between elderly and younger patients.
  
  
  METHODS
  We conducted a retrospective analysis using the National Hospital Discharge Survey. Source of admission to the hospital was evaluated for years 2003 to 2009. Total admissions from the ED and trends over time were analyzed for the following age groups: 22 to 64, 65 to 74, 75 to 84, and 85+ years old. Likelihood of having been admitted from the ED was evaluated with logistic regression.
  
  
  RESULTS
  A total of 1.7 million survey visits representing 216 million adult hospitalizations were analyzed. A total of 93 million (43.2%) were among patients 65 years and older. The ED was the source of admission for 57.3% of patients 65 years and older and 44.4% of patients 64 years and younger (95% confidence interval difference, 12.97%-13.00%). By 2009, more than 75% of nonelective admissions for patients 85 years and older were through the ED. There was a linear relationship between age and the ED as the source of admission, the odds increasing by 2.9% per year (95% confidence interval, 1.029-1.029) for each year beyond age 65 years.
  
  
  CONCLUSIONS
  Emergency departments are increasingly used as the gateway for hospital admission for older adults. An aging US population may increase the effect of this trend, a prospect that should be planned for. From the patient perspective, barriers to care contributing to the age-based discrepancy in the use of the ED as source of admission should be investigated.
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: petergreenwald@gmail.com.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Greenwald
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: rme2001@nyp.org.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Estevez
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: suc2010@med.cornell.edu.
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: mestern@med.cornell.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Stern
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: trosen73@gmail.com.
authors.forename: Tony
authors.initials: T
authors.lastname: Rosen
authors.affiliation: Emergency Department, Weill Cornell Medical College, New York, NY 10065. Electronic address: nef2002@med.cornell.edu.
authors.forename: Neal
authors.initials: N
authors.lastname: Flomenbaum
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult