Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care

Objective: To describe factors predicting frequent emergency department (ED) use among rural older adults receiving home care services in Ontario, Canada. Design: A cross-sectional examination of Ontario hospital administrative data linked to provincial home care data compares frequent ED users (i.e. >4 visits/year) with regular users (i.e. 1-3 visits/year) and no ED use over a 1-year period. Multiple logistic regression analysis was performed using independent variables from home care health assessments. Main outcome measures: Predictors of frequent ED use among rural older adults receiving home care services using adjusted odds ratios (ORs) and 95% confidence intervals (CI). Results: Ontario's rural home care clients visited the ED an average of 4.9 times (SD=11.9) over a year. Frequent ED users were observed in 170 cases per 1000 home care clients. Congestive heart failure was the most frequently cited reason for frequent ED use; however, it was not a main driver in the adjusted model. Frequent ED use was predicted by younger age (i.e. 60-74 years) (OR=1.9; 95% CI, 1.7-2.2), a recent ED visit in the last 3 months (OR=1.5; 95% CI, 1.4-1.7), regularly taking >9 medications (OR=1.5; 95% CI, 1.3-1.6), and poor self-rated health (OR=1.4; 95% CI, 1.2-1.5). Conclusion: Despite popular assumptions, the main drivers for frequent ED use among rural older adults in Ontario included a mix of sociodemographic and clinical characteristics, rather than disease diagnoses.