TY - JOUR T1 - Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. JF - Health Aff (Millwood) Y1 - 2012 A1 - Alexander K Smith A1 - Ellen P McCarthy A1 - Ellen Weber A1 - Irena Cenzer A1 - W John Boscardin A1 - Jonathan Fisher A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Emergency Service, Hospital KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Insurance Claim Review KW - Male KW - Terminal Care KW - Terminally Ill KW - United States AB -

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

PB - 31 VL - 31 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22665840?dopt=Abstract U2 - PMC3736978 U4 - elderly/Medicare/Primary Care/public policy/Health care policy/emergency department service use/emergency department service use ER -