New thesis explores factors explaining emergency care use among older persons

Mahwish Naseer has defended her thesis entitled "Why do older adults seek emergency care? The impact of contextual factors, care, health, and social relations".
Person holding elderly persons hand.

Mahwish Naseer, School of Health and Welfare at Dalarna University, and Doctoral Studentat at the Division of Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society at Karolinska Institutet.

The focus of my thesis has been to explore factors explaining emergency care use among older people. I have examined factors at the individual level (e.g., health status, living arrangements, social relations, care receipt) and at the contextual level (e.g., the proportion of older persons in the total population, annual social care expenditures, and the distance to the emergency department). 

Which are the most important results?

A general perception is that unnecessary emergency care visits are common among older adults. However, my results do not support this perception. Emergency care visits among older adults are driven by a need for care. In addition to poor health status, older persons living at home and receiving home help for instrumental services and personal care were more likely to visit emergency care and revisit emergency care within 30 days.

Another important finding was that older people who were discharged home instead of being admitted to inpatient care from the emergency department, were at higher risk of emergency care revisit within 30 days of the initial visit. This result suggests that needs of care and post-discharge care were unmet.

Previous research on emergency care has primarily focused on individual level factors. In my thesis, greater proportions of persons 80 years or older in the total population, and shorter distance to the emergency department, increased the risk of emergency visits. To understand emergency care use in older people we must thus consider the context in which people live.

How can this new knowledge contribute to the improvement of health-related outcomes in older people?

An increase in aged population poses challenges for the social and health care of older persons. The proportion of adults aged 80 years or older in Sweden’s population is expected to increase approximately 250 000 persons by 2030, which is an approximate increase of 45%. In line with the ‘ageing in place’ policy and deinstitutionalisation, older adults, and even frail older adults, will to a large extent stay and receive care in their ordinary homes.

Findings on home help receipt and emergency care use illustrate the vulnerability of this group. To meet the needs of older people, greater continuity in social care and primary health care, and collaboration between social care and health care providers are required. Improvements in care should be based on older peoples’ views and care should be flexible to individual preferences.

Furthermore, it is crucial to consider the needs of this group in emergency care settings to ensure adequate post-discharge care. For example, geriatric mobile care teams and follow-up visits at home or at primary care clinic may reduce the risk of emergency care revisits and improve health-related outcomes in older adults.

Contextual factors can enhance our understanding of emergency care use in older adults and such factors are often modifiable to meet the care needs of older people. 

Adequate social and outpatient health care could potentially reduce the avoidable emergency care visits. An increase in the use of emergency care indicates ineffective social and healthcare systems, limited resources, and collaboration, and how care is organised.

What are your future plans? Will you keep on conducting research?

Yes, absolutely. Research is important for gaining empirical knowledge and improve the evidence-based for how care can meet people’s needs. I enjoy conducting research and I would like to continue in research. I am particularly interested in exploring aspects contributing to the improvement of health-related outcomes in older people. 

The news article was originally published on Karolinska Institutet's website.

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