Reasons for repeated emergency department visits among community-dwelling older adults with dementia in Ontario, Canada
Reasons for repeated emergency department visits among community-dwelling older adults with dementia in Ontario, Canada
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DOI：
10.1111/jgs.17726
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发表时间：
2022-03-03
影响因子：
6.3
通讯作者：
Bronskill, Susan E.
中科院分区：
文献类型：
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作者：
Jones, Aaron;Maclagan, Laura C.;Bronskill, Susan E.
社区老年痴呆症患者比其他老年人更频繁地去急诊室（艾德）就诊，但缺乏对重复就诊原因的研究。我们在一组痴呆患者中检查了重复艾德就诊率和就诊原因。方法我们对加拿大安大略社区居住的老年痴呆症患者（≥ 66岁）进行了一项基于人群的回顾性队列研究，这些患者于2010年4月1日至2019年3月31日期间访问了艾德并出院回家。我们计算了基线访视后1年内有1次、2次和3次或3次以上重复艾德访视的人群比例，并对访视原因进行了分类。结果我们的队列包含175，863名至少去过艾德一次的痴呆患者。总体而言，66.1%在1年内至少返回艾德一次，39.4%返回两次，23.5%返回3次或更多次。访视原因各不相同，最常见的与一般体征和症状相关（25.3%），而认知或行为原因不常见（5.9%）。在连续的访问中，个人通常出于不同的原因访问。结论社区居住的老年痴呆症患者谁访问了艾德很可能在一年内返回到艾德，有相当大的比例访问多次。由于不同原因而多次覆诊的情况，显示照顾这类人士的工作十分复杂，并显示更有需要提供全面的社区和基层护理服务，以及艾德与社区之间的适时沟通。
Background Community-dwelling older adults living with dementia visit the emergency department (ED) more frequently than other older adults, but research on the reasons for repeated visits is lacking. We examined the rate of repeated ED visits and reasons for visits in a cohort of individuals with dementia. Methods We conducted a population-based retrospective cohort study of community-dwelling older adults (>= 66 years) living with dementia in Ontario, Canada, who visited the ED and were discharged home between April 1, 2010, and March 31, 2019. We calculated the proportion of the population with one, two, and three or more repeat ED visits within 1 year of the baseline visit and the categorized the reason for the visits. Results Our cohort contained 175,863 individuals with dementia who visited the ED at least once. Overall, 66.1% returned at least once to the ED within 1 year, 39.4% returned twice, and 23.5% returned 3 or more times. Visit reasons were heterogenous and were most frequently related to general signs and symptoms (25.3%) while being infrequently due to cognitive or behavioral reasons (5.9%). Individuals typically visited for different reasons across successive visits. Conclusions Community-dwelling older adults with dementia who visited an ED were very likely to return to the ED within a year, with a substantial proportion visiting multiple times. The high frequency of repeated visits for different reasons highlights the complexity of caring for this population and indicates greater need for comprehensive community and primary care as well as timely communication between the ED and the community.