Clinical and socio-demographic factors associated with older adult frequent users of Paris emergency departments: A nested case–control study

Resumen

Objectives: To identify socio-demographic and clinical factors associated with older adult frequent users (FU) of emergency departments (ED).

Methods: We conducted a two-level case–control study nested in a cohort of patients aged ≥ 75 years presenting to 3 emergency departments (ED) in Paris from January 1, 2018 and December 31, 2019. We defined the index date as the last visit during this period. Cases were FU defined as patients with ≥ 4 ED visits during the year preceding the index date. Controls were non-FU (ie, patients with < 4 ED visits). We first analyzed socio-demographic factors associated with FU. Then we randomly selected a convenience sample of 300 patients (150 FU and 150 non-FU), stratified by center, to assess clinical factors associated with FU. Statistical analysis involved multivariate logistic regression models.

Results: From January 1, 2018 to December 31, 2019, 29 009 older patients consulted in the 3 EDs; 1241 (4.3% [95% CI: 4.1-4.5]) patients were FU of an ED in the year preceding the index date. Characteristics independently associated with FU were advanced age (odds ratio [OR] 1.03 [95% CI 1.02-1.04]), male sex (OR 1.15 [1.02-1.29]), presence of comorbidities (history of falls, OR 2.42 [1.27-4.70]), stroke (OR 4.07 [1.84-9.69]), cognitive impairment (OR 2.53 [1.20-5.45]), loss of autonomy (OR 2.70 [1.38-5.41]), use of diuretics (OR 2.10 [1.09-4.11]) or benzodiazepines (OR 2.27 [1.07-5.00]).

Conclusion: The most fragile and comorbid patients are at increased risk of being FU of EDs. These patients should be identified in the ED to adapt management.