EMERGENCY MEDICAL TRANSPORT OF THE ELDERLY - A POPULATION-BASED STUDY

Patterns of utilization of emergency medical services transport (EMS) by the elderly are poorly understood. We determined population-based r ates of EMS utilization by the elderly and characterized utilization p atterns by age, gender, race, and reason for transport. This observati onal, population-based study was conducted in Forsyth County, NC, a se mi-urban county served by one convalescent ambulance service and one E MS service. Using data on all 1990 EMS transports and the 1990 U.S. ce nsus data, age-, gender-, and race-specific transport rates for person s aged 60 or older were calculated. Reasons for transport and frequenc y of repeat users were established. After exclusion of transports beca use of an address outside the county, a nonhospital destination, a sch eduled transport, or missing data, 4,688 transports (78% of total) rem ained for analysis. The overall rate of transport was 104/1,000 county residents, Transport rates increased for successively older five-year age groups, demonstrating a 5.7-fold stepwise increase from ages 60-6 5 to 85+ (51/1,000 to 291/1,000), There was no difference in mean age between patients who were frequent EMS users (more than three transpor ts during the year) (n = 66) and other elderly transportees. Reasons f or transport differed little between those 60 to 84 years of age and t hose 85 years of age and older with the exception of chest pain, cardi ac arrest, and seizures, all of which were significantly more prevalen t in the younger age group. African-Americans used EMS at a rate 1.7 t imes that of whites (143.4/1,000 v 95.4/1,000, 95% confidence internal [CI] 1.40 to 1.61), but there was little difference between genders ( 0.99, 95% CI 0.93 to 1.05). Our data show that in this county, the use of EMS transport increases dramatically with age. The need for EMS tr ansport of elderly patients will increase dramatically as the U.S, pop ulation ages. These findings have implications for care of the individ ual patient and for future changes in health policy. Copyright (C) 199 5 by W.B. Saunders Company