| Research in the United States, Australia, the United Kingdom, and Japan have demonstrated that the elderly are the largest users of Emergency Medical Services (EMS), with the rate of use increasing exponentially with age. Unfortunately, there is a paucity of research that addresses the use of EMS by the elderly in Canada. The objectives of this study were: (a) to conduct focus group interviews with Registered Nurses and Paramedics in order to identify the issues, challenges, and concerns that are encountered when an elderly individual is transferred to an acute care facility by ambulance; (b) to determine the demographic and clinical differences between elderly EMS service recipients picked up in the community versus institutional settings; (c) to determine what factors are predictive of procedural intensity among elderly recipients of EMS services; (d) to identify what risk factors are associated with the use of Emergency Departments (ED) by complex continuing care hospital patients and patients from long term care nursing homes, and (e) to examine factors relevant to hospitalization of complex continuing care patients. The focus group interviews were analyzed using an ethnographic content analysis approach Quantitative data used to address the second and third objectives were collected from Ambulance Call Reports (ACR) completed on patients aged 65 and older between January 1, 2002 - June 30, 2002. Data for the last two objectives were abstracted from the Minimum Data Set (MDS) Modified for Chronic Care Institutions (Version 2.0). Findings from the qualitative analyses revealed that lack of communication among the health care professionals in long term care homes, EMS and local EDs, is an important barrier to good quality care. Quantitative data analyses with the information from the ACRs demonstrated while patients from institutionalized care settings may be more medically complex, community dwelling patients tend to have a higher acuity level when they require EMS. Consequently, the community dwelling patients have a higher level of procedural intensity. With respect to the fourth objective, results indicated that patients from long term care homes are almost 4.5 times more likely to have an ED visit than patients from continuing complex care facilities after controlling for clinical differences between the two care settings. Finally, results pertaining to discharge of complex continuing care patients revealed that while rates of hospitalization are relatively low, there are certain clinical variables that are predictive of future discharges to acute care hospitals. Study limitations and recommendations are presented within the thesis. |
