Insufficient Help for ADL Disabilities and Future ED Utilization

BACKGROUND. Insufficient help for activities of daily living (ADL) disabilities is associated with self-reports of skin breakdown, going hungry, and injuries. Prior research has not determined whether self-reports of health consequences are predictive of need for emergency department (ED) services. We hypothesized that insufficient human help for ADL disabilities is associated with greater risk for ED utilization.

METHODS. Community-living older adults who responded to the 1994, 1999 and 2004 community interviews of the National Long Term Care Survey (NLTCS) were queried about their ADL status, demographic and health characteristics. ED utilization was determined from linked Medicare records. A Cox proportional hazards model was computed to estimate the hazard of ED use for those with insufficient ADL assistance after adjustment for demographics, ADL level, and co-morbidities.

RESULTS. All subjects had at least one ADL disability; 33% were less than 75 years old, 71% were female, 85% were white, 39% were living alone, and 22% of subjects reported insufficient help for one or more ADL disabilities. Rates of more than one ED admission were 28% and 34%, respectively, for those who did and did not report insufficient ADL help. Compared to those with sufficient ADL help, the hazard of subsequent ED admission for those who reported insufficient help was 1.15 (95% CI =1.01- 1.44).

CONCLUSION. Results suggest that self-reports of insufficient help are associated with health events that lead to ED utilization. Future studies are needed to determine whether interventions that reduce reports of insufficient help also reduce ED utilization.