Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study

作者：Anita Chary, Annika Bhananker, Michelle Suh, David Leavitt, Elise Brickhouse, Shreya Tamma, José M. Ramı́rez, Mariana Rios, Aanand D. Naik, Margaret Samuels‐Kalow, Naomi George · 发表于：Journal of the American Geriatrics Society · 年份：2025 · DOI：10.1111/jgs.19616 · 被引用次数：4 · 研究领域：Emergency and Acute Care Studies、Chronic Disease Management Strategies、Healthcare Policy and Management

BACKGROUND: The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN). METHODS: We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use. RESULTS: Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chr...