Background
Methods
Inclusion and exclusion criteria
Study selection and data extraction
Risk of bias/quality assessment
Results
Search results
Study characteristics
Author (year) | Country of origin | Study design (data source) | Year of data | Sample | Mean age of residents (% female) |
---|---|---|---|---|---|
Ackermann et al. (1998) [22] | USA | Retrospective chart review (ED records and data from the 1995 State of Georgia Annual Nursing Home Questionnaire) | 1995 | 10 NHs with 1300 beds and 4 hospital-based EDs | 65–74 years: 20.7%a 75–84 years: 34.3%a 85+ years: 29.0% (67.4%) |
Hsiao and Hing (2014) [15] | USA | Cross-sectional study (data from the ED component of the 2001–2008 National Hospital Ambulatory Medical Care Survey (NHAMCS)) | 2001–2008 | NHRs ≥ 65 years (no sample size given) | No data available |
Kihlgren et al. (2014) [14] | Sweden | Cross-sectional follow-up study (RN’s documentation + Residents Assessment Instrument/Minimum Data Set (MDS)) | 2000–2002 | 719 NHRs ≥ 75 years from 24 NHs | Ø 85.8 years (71.0%) |
LaMantia et al. (2016) [23] | USA | Retrospective cohort study (merged data set of Medicare and Medicaid claims and resident-level Minimum Data Set (MDS)) | 1999–2009 | 4491 long-stay NHRs ≥65 years | Ø 79.6 years (66.2%)a |
McGregor et al. (2014) [18] | Canada | Retrospective cohort study (secondary administrative data on NHRs and ED records) | 2005–2008 | 13,140 NHRs from 48 publicly funded NHs | Ø 83.1 years (66.6%) |
Stephens et al. (2012) [24] | USA | Cross-sectional study (NH resident assessment data/Minimum Data Set (MDS) and Centers for Medicare and Medicaid Services (CMS) administrative claims)b | 2006 | 132,753 NHRs ≥ 65 years from 2006 national random sample | 65–75 years: 19.5% 76–85 years: 41.2% 86+ years: 39.3% (68.7%)a |
Stephens et al. (2014) [25] | USA | Retrospective cohort study (Medicare administrative claims and NH resident assessment data/Minimum Data Set (MDS))b | 2006 | 112,421 NHRs ≥ 65 years from 2006 national sample | 65–75 years: 19.6% 76–85 years: 41.0% 86+ years: 39.4% (68.9%) |
Quality appraisal of included studies
Author (year) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
---|---|---|---|---|---|---|---|---|---|
Ackermann et al. (1998) [22] | Yes | Yes | Yes | Yes | Not applicable | Yes | Yes | No | Yes |
Hsiao and Hing (2014) [15] | Yes | Yes | Yes | Yes | Not clear | Yes | Yes | Yes | Yes |
Kihlgren (2014) [14] | Yes | Yes | Yes | Yes | Not clear | Yes | Yes | Yes | Yes |
LaMantia et al. (2016) [23] | Yes | Yes | Yes | Yes | Not applicable | Yes | Yes | Yes | Yes |
McGregor et al. (2014) [18] | Yes | Yes | Yes | Yes | Not applicable | Yes | Yes | Yes | Yes |
Stephens et al. (2012) [24] | Yes | Yes | Yes | Yes | Not applicable | Yes | Yes | Yes | Yes |
Stephens et al. (2014) [25] | Yes | Yes | Yes | Yes | Not applicable | Yes | Yes | Yes | Yes |
Resident characteristics
Frequency of ED visits
Author (year) | Prevalence, incidence or number of ED visits and follow-up | Age-specific and sex-specific analyses | Admission to hospital | Number of ED visits per resident | |
---|---|---|---|---|---|
Prevalence or incidence | Regression/model | ||||
Ackermann et al. (1998) [22] | 110 visits per 100 resident years (1488 ED visits made by 873 residents) Follow-up: 1 year | Holm’s Sequential Rejection Algorithm Men had a 17% higher overall ED use rate than women (p = 0.025). No association between the overall ED use rate of a NH and the age distribution of its patients.a | Admitted to hospital: 42.4% Not admitted: 56.3% Died: 1.3% Admitted to hospital: Age ≤ 64 years: 36.6% 65–74 years: 44.9% 75–84 years: 41.8% 85+ years: 44.6% Sex Female: 41.6% Male: 43.9% | Number of ED visits per resident 1: 60.5% 2: 22.3% 3: 9.5% 4: 4.2% 5+: 3.4% | |
Hsiao and Hing (2014) [15] | 123.2 visits per 100 resident years (4970 ED visits) Follow-up: 1 month | Number of visits per 100 resident years Age 65–74 years: 153.2 (95% CI 138.1–168.3) 75–84 years: 124.3 (95% CI 115.5–133.1) 85+ years: 113.0 (95% CI 105.0–121.0) Sex Female: 111.6 (95% CI 104.5–118.7) Male: 154.5 (95% CI 142.3–166.7) | Admitted to hospital: 48.7% Not admitted: 33.5% Multivariable analysis Admitted to hospital: Age 65–74 years: Reference 75–84 years: OR = 0.95 (95% CI 0.75–1.20) 85+ years: OR = 1.02 (95% CI 0.82–1.27) Sex Male: OR = 1.10 (95% CI 0.93–1.30) | Proportion of residents seen in ED less than 72 h ago: 2.4% (95% CI 1.9–3.0) | |
Kihlgren et al. (2014) [14] | 150 visits per 100 resident years NHRs with at least one ED visit: 29% (314 ED visits made by 209 residents) Follow-up: 1 year | Age 75–84 years: 25% 85+ years: 30% (p = 0.213) Sex Female: 28% Male: 33% (p = 0.196) | Number of ED visits per resident 1: 71% (number of referrals ranged between 1 and 7) Average number of referrals: Female: 1.4 Male: 1.7 | ||
LaMantia et al. (2016) [23] | 2001: 146.0 visits per 100 resident years 2008: 215.5 visits per 100 resident yearsb NHRs with at least one ED visit: 47% Follow-up: 1 year | Multivariable cox proportional hazard regression Age HR = 0.98 (95% CI 0.98–0.99; p < 0.0001) Sex Male: HR = 0.95 (95% CI 0.87–1.05; p = 0.3610)c | Admitted to hospital: 36.4% Not admitted: 63.1% Died: 0.52% | ||
McGregor et al. (2014) [18] | 62.6 visits per 100 resident yearsc,d (10,710 ED visits) Follow-up: 3 years | Poisson regression Adjusted (for sex and age) Age IRR = 1.00 (95% CI 1.00–1.00) Sex Male: IRR = 1.38 (95% CI 1.28–1.49) | |||
Stephens et al. (2012) [24] | NHRs with at least one ED visit: 62% (82,335 ED visits) Follow-up: 1 year | Age 65–75 years: 62.7% 76–85 years: 63.9% 86+ years: 59.7% Sex Female: 60.5% Male: 65.3% | Multivariable logistic regression Age 65–75 years: Reference 76–85 years: OR = 1.11 (95% CI 1.07–1.15; p ≤ 0.0001) 86+ years: OR = 1.03 (95% CI 0.99–1.07) Sex Male: OR = 1.05 (95% CI 1.02–1.09; p ≤ 0.001) | ||
Stephens et al. (2014) [25] | ED visits: 112,119 Follow-up: 1 year | Poisson regression Adjusted Age 65–75 years: Reference 76–85 years: IRR = 0.95 (95% CI 0.93–0.97; p < 0.0001) 86+ years: IRR = 0.90 (95% CI 0.88–0.92 p < 0.0001) Sex Male: IRR = 1.14 (95% CI 1.12–1.17; p < 0.0001) | Admitted to hospital: 44.16% Multivariable logistic regression Admitted to hospital: Age 65–74 years: Reference 76–85 years: OR = 1.07 (95% CI 1.02–1.13) 86+ years: OR = 1.11 (95% CI 1.05–1.17) Sex Male: 1.10 (95% CI 1.06–1.15) |