First aid training for laypeople.

Between 1995 and 2005, the number of emergency department (ED) visits nationwide increased from 96.5 million to 115.3 million. Meanwhile, the number of EDs in the United States has decreased according to the National Hospital Ambulatory Medical Care Survey (NHAMCS). This has led to increasing ED crowding and increased cost and stress for patients and caregivers. Patients who use the ED on a frequent basis may contribute to ED crowding and are reflective of continually increasing ED utilization (). Studies have also found that a growing percentage of frequent ED users are over 65 years of age, and this rate is increasing (). Older persons constitute up to 20% of all ED encounters, are more likely to be admitted to the hospital, and are more likely to have repeat visits to the ED (). It has been hypothesized that frequent users lack health care access or insurance and use the ED for non-urgent care in lieu of the outpatient setting. Recent studies, however, contradict this hypothesis and have instead shown ED overuse to be related to multiple factors including illness severity, patient perception of outpatient vs. ED care, and barriers to timely access to primary care. A study using the 2000–2001 Community Tracking Study Household Survey found that 84% of frequent users (≥4 visits annually) had health insurance and 81% had access to non-emergency outpatient care. In fact, patients lacking a usual source of care were less likely to be frequent users. Frequent users were also more likely to be in poorer physical and mental health than infrequent users (). An analysis of all non-federal, acute care hospitals in Massachusetts found similar results, with 85% of frequent users (≥5 visits annually) having health insurance. Frequent users were more likely to be admitted and more likely to die in the ED, suggesting that they were generally sicker than infrequent users (). Furthermore, studies have also shown that some patients prefer care in the ED due to dissatisfaction with primary care or feeling that their medical needs will be met more quickly in the ED setting (,). According to the NHAMCS, between 1995 and 2005 the number of ED visits made by patients aged 65–74 years increased 11%, making it one of the fastest growing age groups in terms of ED use (). The ED is a significant source of care for older adults, serving multiple functions: a treatment center for true emergencies, a point of entry into the hospital for admissions, an easily accessible source of primary care, and a safety net when transition into other health care facilities is disrupted (,). Compared with younger adults, older adults use the ED more frequently, stay in the ED longer, are more likely to be admitted, make repeat visits, and have higher rates of adverse health outcomes after discharge (,).