title: Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established.
abstract: BACKGROUND
  The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users".
  
  
  METHODS
  A retrospective study was performed during the calendar year 2014 (1st January 2014 - 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.
  
  
  RESULTS
  A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4-1.7) and hospitalization (OR 3.8: CI 3.7-4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9-3.2).
  
  
  CONCLUSIONS
  Older patients presented clinical and social characteristics related to the definition of "elderly frail frequent users". The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.
  
  
  CONCLUSIONS
  Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly.
authors.affiliation: Department of Medical Systems, University of Rome Tor Vergata, Foundation Policlinico Tor Vergata, Rome, Italy.|Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy.
authors.forename: Jacopo M
authors.initials: JM
authors.lastname: Legramante
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Morciano
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lucaroni
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gilardi
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Caredda
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pesaresi
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Coscia
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Orlando
authors.affiliation: Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Brandi
authors.affiliation: Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Giovagnoli
authors.affiliation: Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy.
authors.forename: Vito N
authors.initials: VN
authors.lastname: Di Lecce
authors.affiliation: Sanitary Director, Foundation Policlinico Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visconti
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012189:Retrospective Studies; D018570:Risk Assessment