The ED as the primary source of hospital admission for older (but not younger) adults



      The elderly population in the United States is growing. This age shift has important implications for emergency departments (EDs), which currently account for more than 50% of inpatient hospitalizations. Our objective was to compare the percentage of inpatient admissions starting in the ED between elderly and younger patients.


      We conducted a retrospective analysis using the National Hospital Discharge Survey. Source of admission to the hospital was evaluated for years 2003 to 2009. Total admissions from the ED and trends over time were analyzed for the following age groups: 22 to 64, 65 to 74, 75 to 84, and 85+ years old. Likelihood of having been admitted from the ED was evaluated with logistic regression.


      A total of 1.7 million survey visits representing 216 million adult hospitalizations were analyzed. A total of 93 million (43.2%) were among patients 65 years and older. The ED was the source of admission for 57.3% of patients 65 years and older and 44.4% of patients 64 years and younger (95% confidence interval difference, 12.97%-13.00%). By 2009, more than 75% of nonelective admissions for patients 85 years and older were through the ED. There was a linear relationship between age and the ED as the source of admission, the odds increasing by 2.9% per year (95% confidence interval, 1.029-1.029) for each year beyond age 65 years.


      Emergency departments are increasingly used as the gateway for hospital admission for older adults. An aging US population may increase the effect of this trend, a prospect that should be planned for. From the patient perspective, barriers to care contributing to the age-based discrepancy in the use of the ED as source of admission should be investigated.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Morganti Gonzalez K.
        • Bauhoff S.
        • Blanchard J.C.
        • Abir M.
        • et al.
        Research report: the evolving role of emergency departments in the United States.
        RAND Corporation, Santa Monica2013 (2013)
        • Wilber S.T.
        • Gerson L.W.
        • Terrell K.M.
        • et al.
        Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.
        Acad Emerg Med. 2006; 13: 1345-1351
        • Hawkins M.
        Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates.
        ([Accessed 11/29/2014])
        • Schuur J.D.
        • Venkatesh A.K.
        The growing role of emergency departments in hospital admissions.
        N Engl J Med. 2012; 367: 391-393
        • Schumacher J.G.
        Emergency medicine and older adults: continuing challenges and opportunities.
        Am J Emerg Med. 2005; 23: 556-560
        • Pines J.M.
        • Mullins P.M.
        • Cooper J.K.
        • et al.
        National trends in emergency department use, care patterns, and quality of care of older adults in the United States.
        J Am Geriatr Soc. 2013; 61: 12-17
      1. United States Census Bureau. Age and Sex Composition.
        GPO, Washington2010 ([ accessed 11/29/2014])
        • Werner C.A.
        The older population: 2010. Census brief C2010BR–09.
        U.S. Census Bureau, Washington, DC2011
      2. American College of Emergency Physicians Report on: The Future of Geriatric Care in our Nation's Emergency Departments: Impact and Implications.
        • Roskos E.R.
        • Wilber S.T.
        The effect of future demographic changes on emergency medicine.
        Ann Emerg Med. 2006; 48: 65
        • McCaig L.F.
        • Burt C.W.
        National Hospital Ambulatory Medical Care Survey: 2003 emergency department summary.
        Adv Data. 2003; 2005: 1-38
        • Dennison C.
        • Pokras R.
        Design and operation of the National Hospital Discharge Survey: 1988 redesign.
        Vital Health Stat. 2000; 1: 1-42
        • Baum S.A.
        • Rubenstein L.Z.
        Old people in the emergency room: age-related differences in emergency department use and care.
        J Am Geriatr Soc. 1987; 35: 398-404
        • Greenwald P.W.
        • Stern M.E.
        • Rosen T.
        • Clark S.
        • Flomenbaum N.
        Trends in short-stay hospitalization for older adults from 990 to 2010: implications for geriatric emergency care.
        Am J Emerg Med. 2014; 32 ([Epub 2013 Dec 11]): 311-314
        • Asplin B.R.
        • Rhodes K.V.
        • Levy H.
        • et al.
        Insurance status and access to urgent ambulatory care follow-up appointments.
        JAMA. 2005; 294: 1248-1254
        • Carrier E.
        • Yee T.
        • Holzwart R.A.
        National Institute For Health Care Reform Coordination Between Emergency and Primary Care Physicians Research Brief No. 3.
        ([accessed 11/29/2014])
        • Hwang U.
        • Morrison R.S.
        The geriatric emergency department.
        J Am Geriatr Soc. 2007; 55: 1873-1876
        • Hartocollis A.
        For the Elderly, Emergency Rooms of Their Own.
        The New York Times. 2012
        • Stern M.E.
        • Flomenbaum N.
        Geriatric emergency medicine.
        J Am Geriatr Soc. 2008; 56: 2368