Trends in Emergency Department Use by Older People in the Western Australian Community and Residential Care

Abstract

Objectives The number of older people in Australia living with disability has grown disproportionately compared with growth in aged care services. We aimed to determine secular trends of emergency department (ED) use of older people in Western Australia (WA) who are living in the community and in residential aged care facilities (RCFs). Design Retrospective cohort study. Setting and Participants We studied all individuals aged 65 years or over living in WA between January 1, 2002 and December 31, 2019, who presented to WA's EDs. Methods Linked data sets were used to track trends in ED use by RCF and non-RCF residents over time. Results Two million, one hundred thirty-seven thousand, five hundred ninety-one presentations from 383,324 individuals were included. During the period 2002 to 2019, the age- and sex-standardized rate ratio of RCF:non-RCF residents decreased, with most diagnoses decreasing to less than 2-fold, although mental disorders and urinary tract infections remained high at 4.7 and 3.4 in 2019. Similarly, patients in RCFs were more likely to be diagnosed with mental disorders [odds ratio (OR), 1.92; 95% CI, 1.89-2.07], hip fracture (OR, 1.60; 95% CI, 1.55-1.66), urinary tract infections (OR, 1.49; 95% CI, 1.43-1.54), and lower respiratory tract infections (OR, 1.22; 95% CI, 1.18-1.25). RCF residents were less likely to be diagnosed with circulatory disorders (OR, 0.87; 95% CI, 0.85-0.90) and neoplasms (OR, 0.38; 95% CI, 0.35-0.42). Conclusions and Implications Although the overall relative use of ED by RCF residents decreased over time, RCF residents continued to have an increased risk of presenting with specific health needs. ED health services should be tailored to the specific needs of RCF residents.