Health care utilization by older adults with geriatric conditions

OBJECTIVES: Geriatric conditions were common but often overlooked in clinical practice. We aimed to analyze the patterns of health care utilization and costs associated with geriatric conditions in Taiwan. METHODS: This study used data from the 2005 National Health Interview Survey and concurrent National Health Insurance database to examine the association between geriatric conditions (i.e. cognitive impairment, depressive symptoms, falls, urinary incontinence, and persistent pain) and utilization of outpatient physician services, emergency department (ED) visits, and hospitalizations by older adults aged 65 or over. Multiple specialty visits were defined as more than 4 different specialties visits within one year. Covariates included age, sex, education, urbanization level, chronic diseases, and functional status. Poisson regression was used to model count data. Costs were transformed based on natural log and analyzed by multivariate regression models. RESULTS: 1,760 participants (female 46.8%, mean age 73.6 yr) were enrolled. After adjustment, older adults with two or more geriatric conditions had higher risk of ED visits [risk ratio, 1.6; 95% confidence interval (CI), 1.2-2.2] and costs, but not outpatient physician services and costs. Having two or more geriatric conditions did not associate with higher risk of hospitalizations, but were associated with longer hospital stay. In addition, having two or more geriatric conditions increased risk of multiple specialty visits [adjusted risk ratio, 1.6; 95% CI, 1.1-2.2]. For specific geriatric condition, depressive symptoms were significantly associated with higher health care utilization. CONCLUSIONS: Proper detection and management of geriatric conditions in ambulatory settings may lower the risk of ED visits.