Frailty Explains Variation in Emergency Department Use for Older Veterans During the COVID-19 Pandemic

Authors

Justine Seidenfeld, Durham VA Health Care SystemFollow
Karen M. Stechuchak, Durham VA Health Care System
Valerie A. Smith, Durham VA Health Care System
Catherine Stanwyck, Durham VA Health Care System
Chelsea Perfect, Duke University School of Medicine
Courtney Van Houtven, Durham VA Health Care System
Susan Nicole Hastings, Durham VA Health Care System

Author ORCID Identifier

0000-0001-6912-7315

Abstract

Background: Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty

Methods: Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.

Results: Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.

Conclusions: Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Seidenfeld, Justine; Stechuchak, Karen M.; Smith, Valerie A.; Stanwyck, Catherine; Perfect, Chelsea; Van Houtven, Courtney; and Hastings, Susan Nicole (2024) "Frailty Explains Variation in Emergency Department Use for Older Veterans During the COVID-19 Pandemic," Journal of Geriatric Emergency Medicine: Vol. 5: Iss. 3, Article 4.
DOI: https://doi.org/10.17294/2694-4715.1080
Available at: https://institutionalrepository.aah.org/jgem/vol5/iss3/4