Academic journal article Australian Health Review

Trends and Predicted Trends in Presentations of Older People to Australian Emergency Departments: Effects of Demand Growth, Population Aging and Climate Change

Academic journal article Australian Health Review

Trends and Predicted Trends in Presentations of Older People to Australian Emergency Departments: Effects of Demand Growth, Population Aging and Climate Change

Article excerpt

Introduction

Background and rationale

Older people have complex care needs that are highly time and resource intensive.1-3 They have further been identified as a vulnerable population in the emergency department (ED) environment, having substantially inferior clinical outcomes after discharge from the ED,4-6 with higher rates of missed diagnoses and medication errors compared with younger, severity-matched controls.7-9 Internationally, presentations of older people to EDs are projected to increase markedly as a result ofrapid population aging.10

The Madrid International Plan of Action on Ageing stressed the need to integrate issues of aging into all relevant policy arenas, through collection and analysis of age-disaggregated data, this being central to ensuring that policies respond to needs of the elderly and that efficiency of resource utilisation is optimised.11 ED funding models in Australia do not adjust funding based on the age of the patient and, currently, with a focus on activity-based funding, do not incentivise investment in ED substitutive care or avoidance models of care.12,13

In order to better inform Australian health policy and facilitate development of funding models and models of healthcare that deliver optimal acute health care to Australians, a detailed understanding of trends in and effects of population ageing on ED presentations across Australia is essential.

Objectives

The present study involved secondary analysis of age-disaggregated data from July 2006 to June 2011, using the National Non-admitted Patient Emergency Department Care Database (NNAPEDCD). Specific objectives of the study were to: (1) describe the age and gender distribution of people presenting to EDs; (2) describe the trends in number of ED presentations to public EDs across Australia of older people compared with younger people; and (3) develop ED utilisation projections to assess trends in ED presentations to 2050, based on predicted population trends, demonstrated growth in ED presentations and potential effects of climate change.

Methods

Study design

A retrospective analysis of data collected in the NNAPEDCD was undertaken. The NNAPEDCD is a national database administered by the Australian Institute of Health and Welfare (AIHW) that describes episode-level presentations to public EDs across Australia. The research team purchased de-identified data across 15 data elements from the AIHW. The data elements provided were determined by availability, data integrity and consent of state data custodians. State data custodians provided stipulations on data elements to be provided, their format, use and reporting. The data custodians further required that no comparative state-level data be published. The study was granted ethics approval by the University of Queensland Medical Research Ethics Committee.

Variables

NNAPEDCD variables

Data representativeness was assessed by distribution of presentations by state or territory of hospitalisation, by year and by hospital peer group (hospital groupings that allow for comparison of hospital performance across hospitals with similar characteristics).

As a requirement of state data custodians, all visits to EDs from July 2006 to June 2011 were stratified by age group. The age groups used were based on the groupings that fulfilled study requirements and were broadly consistent with the age ranges defined by both the National Health Data Dictionary14 and demographic projections of the Australian Bureau of Statistics (ABS),15 specifically 0-64 years (young people), 65-84 years (older people) and >85 years (oldest old). Trends over time of ED presentations by age group were assessed. Gender and hospital peer group of ED presentations by age group were also examined.

ABS variables

Projected population estimates over three population growth scenarios from the ABS, with their conservative assumptions of fertility, life expectancy and immigration, were used to assess the rate of ED presentations by population. …

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