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Association between the elderly frequent attender to the emergency department and 30-day mortality: A retrospective study over 10 years

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Yuzeng Shen1, Yee Chien Tay2, Edward Wee Kwan Teo3, Nan Liu4, Shao Wei Lam4, Marcus Eng Hock Ong1


1 Department of Emergency Medicine, Singapore General Hospital, Singapore


2 Department of Emergency Medicine, Sengkang Health, Singapore


3 Business Analytics Program, National University of Singapore, Singapore


4 Singhealth Health Services Research Centre, Singapore


Corresponding Author: Yuzeng Shen, Email: shen.yuzeng@singhealth.com.sg


© 2018 World Journal of Emergency Medicine


DOI: 10.5847/wjem.j.1920–8642.2018.01.003


BACKGROUND: To determine if elderly frequent attenders are associated with increased 30- day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality.

METHODS: Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student t-test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender.

RESULTS: 1.381 million attendance records were analyzed. Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking at 10.2% in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year.

CONCLUSION: Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.

(World J Emerg Med 2018;9(1):20–25)


KEY WORDS: Frequent attenders; Elderly; Emergency department; Mortality

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