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Frequent Use of Emergency Medical Services by the Elderly: A Case-Control Study Using Paramedic Records

Published online by Cambridge University Press:  28 June 2012

Niels Tangherlini ,
Mark J. Pletcher ,
Mark A. Covec  and
John F. Brown
Niels Tangherlini*
Affiliation:
Emergency Medical Services Division, San Francisco Fire Department, San Francisco, California, USA
Mark J. Pletcher
Affiliation:
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
Mark A. Covec
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University, New York, New York, USA
John F. Brown
Affiliation:
Department of Emergency Medicine, University of California, San Francisco and San Francisco General Hospital and Trauma Center, San Francisco, California, USA
*
San Francisco Fire Department EMS Division, 698 Second Street, San Francisco, California 94107, USA E-mail: niels.tangherlini@gmail.com
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Abstract

Introduction:

The objective of this study was to identify the factors that lead to increased use of emergency medical services (EMS) by patients ≥65 years of age in an urban EMS system.

Methods:

Retrospective, case-control study of frequent EMS use among elderly patients transported during one year in an urban EMS system. Three distinct groups were examined for transports that took place in 1999: (1) 1–3 transports per year (low use); (2) 4–9 times per year (high use); and (3) those transported 10+ times (very high use). This frequency-use indicator variable is the primary outcome measurement. Predictors included age, gender, preexisting medical diseases, ethnicity, number of medications, number of medical problems, primary physician, psychiatric diagnosis, and homelessness. Analysis of predictors was done using ordinal logistic regression model, and a global test of interaction terms.

Results:

Male gender, black ethnicity, homelessness, and a variety of types of medical problems were associated with increased use of EMS resources. The strongest single predictor of case status remained homelessness, which was nearly eight times as commonly associated with frequent EMS use than for the controls. The number of medical problems and medications also were significantly associated with EMS use in this patient population. There was a lack of association of alcohol, substance abuse, and psychiatric disorders with EMS use. Patients with asthma who did not have a primary care physician were more likely to use EMS services than were those who had a physician.

Conclusions:

This analysis highlights homelessness as being strongly associated with frequent EMS use among the elderly and downplays other associated factors, such as psychiatric disease and substance use. Medical illness severity, particularly asthma when no primary care physician is available, also appears to drive frequent EMS use. Both findings have implications in terms of targeting of public resources; providing housing to medically ill elderly and primary care to asthmatics in particular, may provide dividends not only in terms of social welfare and medical care, but in preventing frequent EMS use by the elderly.

Keywords

elderly patientemergency medical serviceshomelessnessutilization
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 258 - 264
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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