Anita Chary, Annika Bhananker, Michelle Suh, David Leavitt, Elise Brickhouse, Shreya Tamma, Jose Ramirez, Mariana Rios, Aanand D. Naik, Margaret Samuels-Kalow, Naomi George
{"title":"Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study","authors":"Anita Chary, Annika Bhananker, Michelle Suh, David Leavitt, Elise Brickhouse, Shreya Tamma, Jose Ramirez, Mariana Rios, Aanand D. Naik, Margaret Samuels-Kalow, Naomi George","doi":"10.1111/jgs.19616","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chronic disease whose management bordered between outpatient and inpatient settings; (5) had a sentinel event (e.g., fall, surgery) with cascading sequelae; (6) faced recurrent challenges managing indwelling catheters, tubes, and long-term vascular access.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Among socioeconomically disadvantaged older adults in our sample, medical complexity was a more salient driver of frequent ED use than unmet social needs. Innovations to strengthen outpatient care and offer alternatives to ED and hospital admission are needed for this population.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2808-2818"},"PeriodicalIF":4.5000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19616","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19616","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).
Methods
We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use.
Results
Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chronic disease whose management bordered between outpatient and inpatient settings; (5) had a sentinel event (e.g., fall, surgery) with cascading sequelae; (6) faced recurrent challenges managing indwelling catheters, tubes, and long-term vascular access.
Conclusions
Among socioeconomically disadvantaged older adults in our sample, medical complexity was a more salient driver of frequent ED use than unmet social needs. Innovations to strengthen outpatient care and offer alternatives to ED and hospital admission are needed for this population.
期刊介绍:
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.