Six-Month Emergency Department Use among Older Adults Following Jail Incarceration
Six-Month Emergency Department Use among Older Adults Following Jail Incarceration
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DOI：
10.1007/s11524-017-0208-4
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发表时间：
2018-08-01
影响因子：
6.6
通讯作者：
Williams, Brie
中科院分区：
文献类型：
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作者：
Humphreys, Jessi;Ahalt, Cyrus;Williams, Brie
尽管被逮捕并被监禁在监狱的老年人数量正在急剧上升，但人们对他们在急诊室(ED)的使用或与这种使用相关的因素知之甚少。这种知识的缺乏削弱了设计以证据为基础的护理方法以满足这一人群需求的能力。这项为期6个月的纵向研究旨在确定101名55岁或55岁以上的成年人在狱中使用6个月ED的频率，并确定与此相关的因素。主要结果是自基线起6个月内自行报告的急诊科使用情况。其他措施包括基线社会人口学、身心健康状况、老年因素(例如最近跌倒、大小便失禁、功能障碍、对释放后安全的担忧)、症状(疼痛和其他症状)以及行为和社会健康风险因素(例如物质使用障碍、最近无家可归)。使用卡方检验来确定与超过6个月的ED使用相关的基线因素。参与者(平均年龄60岁)报告了多发病(61%)、功能障碍(57%)、疼痛(52%)、严重精神疾病(44%)、最近无家可归(54%)和/或药物使用障碍(69%)的高发生率。在6个月时，46%的人至少去看过一次急诊室；21%的人去过多次。与ED使用相关的因素包括多病(p=0.001.0 1)、功能障碍(p=0.0 2)、丙型肝炎(p=0.0 1)、近期跌倒(p=0.0 3)、疼痛(p<；0.001)、孤独(p=0.0 4)和安全问题(p=0.0 1)。在县监狱的这群老年人中，老年性疾病和令人痛苦的症状很常见，并与6个月的社区ED使用有关。监狱是发展老年护理模式的重要场所，旨在解决并存的医疗、功能和行为健康需求和症状，努力改善护理并减少涉及刑事司法的老年人人口的ED使用。
Although the number of older adults who are arrested and subject to incarceration in jail is rising dramatically, little is known about their emergency department (ED) use or the factors associated with that use. This lack of knowledge impairs the ability to design evidence-based approaches to care that would meet the needs of this population. This 6-month longitudinal study aimed to determine the frequency of 6-month ED use among 101 adults aged 55 or older enrolled while in jail and to identify factors associated with that use. The primary outcome was self-reported emergency department use within 6 months from baseline. Additional measures included baseline socio-demographics, physical and mental health conditions, geriatric factors (e.g., recent falls, incontinence, functional impairment, concern about post-release safety), symptoms (pain and other symptoms), and behavioral and social health risk factors (e.g., substance use disorders, recent homelessness). Chi-square tests were used to identify baseline factors associated with ED use over 6 months. Participants (average age 60) reported high rates of multimorbidity (61%), functional impairment (57%), pain (52%), serious mental illness (44%), recent homelessness (54%), and/or substance use disorders (69%). At 6 months, 46% had visited the ED at least once; 21% visited multiple times. Factors associated with ED use included multimorbidity (p = 0.01), functional impairment (p = 0.02), hepatitis C infection (p = 0.01), a recent fall (p = 0.03), pain (p < 0.001), loneliness (p = 0.04), and safety concerns (p = 0.01). In this population of older adults in a county jail, geriatric conditions and distressing symptoms were common and associated with 6-month community ED use. Jail is an important setting to develop geriatric care paradigms aimed at addressing comorbid medical, functional, and behavioral health needs and symptomatology in an effort to improve care and decrease ED use in the growing population of criminal justice-involved older adults.