NEW ORLEANS — Falls are by far the most common reason for emergency department visits by nursing home patients, a national survey showed.
After injuries from falling, which led to an estimated 14% of all nursing home patients' ED visits in 2004, the top reasons for a trip to the ED included chest pain and pneumonia (4.5% of visits each), psychiatric symptoms (3.7%), and cardiac conditions other than acute coronary syndrome (3.2%), Dr. Scott Wilber reported at the annual meeting of the Society for Academic Emergency Medicine.
Some researchers have said that up to half of all ED visits by nursing home residents are for problems that could have been managed by a visiting primary care physician. But the new data suggest that trauma and serious medical conditions are the typical reasons for the visits, said Dr. Wilber, director of the emergency medicine research center at Northeastern Ohio Universities College of Medicine, Rootstown.
His analysis of data from the 2004 National Nursing Home Survey indicated that there were an estimated 1,492,138 nursing home residents nationally. Their mean age was 80 years, and 71% were women. Residents had been in a nursing home for a mean of 2.3 years and were on a median of nine medications.
Within the last 90 days, 8.3% of nursing home residents had made an ED visit. Of those who went to the ED, 85% did so only once during that period; 11% had two visits.
In a logistic regression analysis, the significant risk factors for the ED visits were issues related to the presence of a gastrointestinal or genitourinary device, being on more than nine medications, weight loss, pressure ulcers, male gender, and having no advance directives. These risk factors ranged in predictive power from a high of a 1.6-fold increased risk for patients with a GI or genitourinary device to a 1.2-fold increase for individuals having no advance directives.
The rate of ED visits by nursing home patients is lower than for noninstitutionalized elderly patients. In 2004, nursing home residents averaged 40.3 ED visits per 100 residents, vs. 57.9 per 100 among noninstitutionalized individuals aged 75 years or older, Dr. Wilber said.
Dr. Wilber's study was funded by the Summa Health System Foundation.