Characteristics and predictors of frequent emergency department presentation and patient-reported care experiences among older adults: A retrospective cohort and survey study.

BACKGROUND: Drivers of frequent emergency department (ED) presentations and patient-reported care experiences for older adults remain unclear. METHOD: A retrospective population-based cohort study of adults aged ≥65 years in New South Wales, Australia, using linked hospital and mortality records and patient-reported ED care experiences. Individuals with an index ED presentation in 2018 who survived the ascertainment period were followed for five years. ED presentation frequency during the remainder of 2018 was classified as low (1-3 ED presentations) or frequent (≥4 ED presentations). Demographic and clinical characteristics were compared. Generalised estimating equation and survey logistic regression models identified factors associated with frequent presentation and negative care experiences. RESULTS: There were 336,283 index presentations in 2018; 10.6% were frequent presenters, mostly aged 75-84 years (38.3%). Frequent ED use was more common among those aged 75-84 years in the first four years (ORs 1.06; 95%CI 1.01-1.11 to 1.27; 95%CI 1.23-1.31) and those aged ≥85 years in the first year (OR 1.33; 95%CI 1.28-1.38). Multimorbidity, rurality, living in aged care, and triage below resuscitation were associated with frequent presentations. Female, dementia, osteoporosis, frailty, non-urgent presentation, and hospitalisation were associated with lower odds of frequent presentation. For patient experience (n=47,461), negative ED experience was associated with long waits (≥60 minutes; OR 1.70; 95%CI 1.19-2.42), complications (OR 1.63; 95%CI 1.16-2.28), and poor communication or involvement in decisions, with insufficient treatment information showing the strongest association (OR 5.17; 95%CI 3.48-7.69). CONCLUSIONS: Frequent ED use in older adults reflects persistent issues in complex health and social needs, communication and shared decision-making.