Major Finding: Of 3,224 seniors reviewed, 74% visited hospital emergency departments during their last 6 months of life and 51% visited during their last month.
Data Source: A cohort of people aged 65 years and older from the Health and Retirement Study and Medicare utilization data.
Disclosures: Dr. Smith had no relevant financial disclosures.
ORLANDO — Almost three-quarters of people aged 65 years and older visit emergency departments in their last 6 months of life, and just more than half do so during their last month, according to a study of 3,224 seniors.
These high utilization rates suggest that emergency department (ED) clinicians should be included in initiatives to improve end-of-life care, such as hospice and better patient-provider communication, Dr. Alexander K. Smith said. “When people come to the ED … it may be an opportunity to change the trajectory of care,” said Dr. Smith of the division of geriatrics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center.
Nursing home residents were less likely than were community-dwelling elders to visit an emergency department. During the last month of life, 41% of the former group and 54% of the latter did so, Dr. Smith said.
Use of ED services also varied considerably in the study by hospice enrollment, ethnicity, and whether the death was expected, which was ascertained through next-of-kin interviews.
Dr. Smith and his associates created a cohort of elderly decedents using data from the Health and Retirement Study, a nationally representative longitudinal survey. During that study, the eventual decedents had been interviewed every 2 years, and Dr. Smith's team focused on the last response prior to death. The study cohort of 3,224 adults included 22% who were 65–74 years old at the time of death between 1995 and 2006, 40% aged 75–85, and 38% older than 85 years at death.
Dr. Smith and his colleagues linked the survey participants' names to Medicare utilization data to find how many had visited EDs in their last months of life. They also looked at visit frequency in this group: 33% visited an ED once, 20% two times, 10% three times, 6% four times, and 5% five times or more.
The researchers compared the figure for how many people went to EDs in their last 1 month of life, 51%, with data for an age-, gender-, and race/ethnicity–matched cohort of elders who did not die in 2006. The researchers found that only 2% of these matched elders visited the ED in a 1-month period.
One aim of the study was to determine factors associated with ED use by dying elders. For example, 3% of hospice enrollees versus 56% of seniors not enrolled in hospice care visited an ED during the last month of life.
Also, 46% of the elders for whom death was expected visited the ED in the last month of life, while 61% of those with unexpected deaths had gone to EDs in that time frame.
“We did not have data on whether or not they had a primary care physician. But we were able to look at whether they visited the doctor frequently, and it was not associated with ED visits,” he said.
'When people come to the ED … it may be an opportunity to change the trajectory of care.'
Source DR. SMITH