1. Utilization of Community Resources in Elderly Patients Presenting to the ED with Psychosocial Problems Rachelle Halasa MS, Chad Sutliffe MHA, Andrew Brown MS, Cindy Ong MS, Ryan Beckett MS, Sunny Shah MS, Deven Patel MS, Kellie Phillips MSW, Jeffrey Jones MD College of Human Medicine, Michigan State University, Grand Rapids; Grand Valley State University, Department of Allied Health Sciences; Spectrum Health Department of Emergency Medicine College of Human Medicine, Michigan State University, Grand Rapids; Spectrum Health Department of Emergency Medicine Introduction As the age and size of the older population group increases, the appropriateness, effectiveness, cost, and outcome of emergency medical care provided to them will be of special concern. Outreach and social service intervention may prove especially critical to older patients who have limitations of mobility, sight, hearing, selfcare capacity, financial resources, or social supports. The aims of this study were to identify key social problems among the elderly as they present to an emergency department (ED). Results Methods This was a retrospective, cohort analysis of consecutive patients more than 64 years old who received medical social work (MSW) consultation in the ED at a university-affiliated hospital during a two-year study period (2012-2013). Demographic information, medical history, presenting complaints, clinical findings, treatment, referral, and disposition were obtained from medical records. The main outcome criterion was the frequency of key social problems among the elderly. Results were compared to data from a similar study performed 25 years ago at our institution. During the study period, 1309 consecutive elderly patients received MSW consultation in the ED. The mean age was 78.4 + 9.1 years; the oldest patient was 100 years old. The majority of elderly lived with a family member or caregiver (47.6%), home alone (31.4%), or in an extended-care facility (12.4%). A total of 18 common psychosocial problems were identified; the most common were caregiver relief, medication assistance and emotional distress (Table 1). Twenty risk factors were identified that predisposed older patients to psychosocial emergencies (Table 2). Compared to a similar study at our institution in 1988-1989: o The ED adult census at the Butterworth campus has increased 120%. o The number of MSW consults in elderly patients has increased 370%. o Patients now have a greater number of psychosocial problems (3.0 vs. 1.9, P<0.001). o The spectrum of psychosocial disease has changed with significantly more terminal illness, caretaking issues, medication assistance, social isolation, and self-neglect. Sixty-one different community resources were utilized during the study period (Table 3). Despite community resources, 44% of elderly patients experienced a change in their living situation after discharge from the ED. Conclusions During the past 25 years at our institution, the number and spectrum of psychosocial emergencies in older patients has significantly changed. There are greater numbers of “high-risk” elderly with caregiver exhaustion, financial constraints, functional decline, depression, self-neglect, and social isolation. Although community-based services can be effective in addressing many of these needs, a growing proportion of elderly with psychosocial emergencies require a change in their living situation upon discharge from the ED. Table 1. Spectrum of Psychosocial Problems in Elderly Patients (N=1309) Caregiver relief 70% Medication assistance 60% Emotional distress30% Isolation 30% Self-neglect 25% Psychiatric 25% Alcohol/drugs 13% Terminal illness 9% Housing 7% Access to medical /dental care 6% Medical equipment 5% Transportation 4% Nutrition 4% Financial assistance 4% Abuse/caregiver neglect 3% Miscellaneous 3% Table 2. Risk Factors That Predisposed Older Patients to Psychosocial Emergencies >5 medications48% Comorbidity36% Hospitalization in past 6 mo31% Social isolation28% History of diabetes25% Living alone25% Functional disability21% Memory impairment19% Recent decline in function16% Terminal illness 15% Premorbid need for help13% Extreme age10% Alcohol/drug use 9% Poor nutrition 8% Depression 7% Poor self-rated health 7% Lack of transportation 6% Language Barrier 2% Homeless 1% Info transfer problems 1% Table 3. Community Resources Utilized (N=61) Pharmacy assistance39.7% Visiting nurse services20.0% Nursing home referral14.5% Hospice 8.6% Community mental health service 7.2% Community medical clinic 5.9% Counseling services 4.1% Support groups 3.7% Detox centers 2.5% Homemaker services 2.4% Senior citizen centers 2.3% Senior companion program 1.6% Shelters 1.0% APS 1.0% Other39.1% This project has been approved by Grand Valley State University’s HRRC, [857004-1].