Half of adults over age 65 made at least one emergency department (ED) visit in the last month of life, in a study led by a physician at the San Francisco VA Medical Center (SFVAMC) and UCSF.

Three quarters of ED visits led to hospital admissions, and more than two-thirds of those admitted to the hospital died there.
In contrast, the 10 percent of study subjects who had enrolled in hospice care at least one month before death were much less likely to have made an ED visit or died in the hospital.

“For too many older Americans, the emergency department is a conduit to hospital admission and death in the hospital,” said lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine doctor at SFVAMC and an assistant professor of medicine in the Division of Geriatrics at UCSF.

The study, published in the June issue of Health Affairs, was based on an analysis of health records of 4,518 people age 65 and older who died while enrolled in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement and aging sponsored by the National Institute on Aging.