Social risks of geriatric patients presenting to the emergency department

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BACKGROUND: Emergency departments (ED) across the country are seeing an increasingly larger portion of visits from patients aged 65 and older due to the overall aging of the United States population. The ED is recognized as an important institution for screening and addressing social risks. Therefore, understanding the social risks of the geriatric ED population is of crucial public health importance. METHODS: This was a subgroup analysis of a prospective cohort study conducted between July 2022 and April 2023 in an ED at a single academic urban quaternary medical center in Los Angeles, California. Clinically stable adult ED patients were screened for social risks and referred to resources where appropriate using a screener composed of 19 questions that cover 12 domains of social determinants of health. Demographic characteristics, number of social risks present, category and degree of social risk, and successful resource provision were recorded and compared between geriatric and non-geriatric adult patients. Age categories associated with having at least one social risk and for greater than one social risk compared to no social risks were assessed by univariate logistic regression analysis. RESULTS: There was a high burden of social risk in this ED geriatric population, with about 70% of individuals screening positive for at least one social risk. Social isolation (47.1%), depression (31.0%), moderate risk (23.6%) and high risk (21.2%) independent living, and moderate risk financial strain (22.6%) were the most frequently reported social risks. Geriatric patients had significantly higher odds of having social risks related to independent living (high risk OR 1.99, 95% CI 1.41–2.82) and alcohol use (OR 1.47, 95% CI 1.03–2.10) compared to non-geriatric adult patients. CONCLUSIONS: This study showed a high burden of social risk in the ED geriatric population at this single institution. Understanding and addressing these social risks through dedicated screening and referral programs may inform the use of institutional resources to support this vulnerable population.

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