Emergency department utilisation in an ageing population: a retrospective observational study

INTRODUCTION: Singapore is among the fastest-ageing nations in the world, and studies have shown a steady rise in emergency department (ED) utilisation among older adults. This study aimed to describe trends and characteristics of ED use in Singapore over a 12-year period and to assess differences in utilisation across age groups. METHODS: Data from 2008 to 2019 on ED visits, admissions, patient characteristics and principal ED diagnoses were extracted from the electronic health records of a tertiary hospital. The primary outcome was admissions through ED, and the secondary outcome was the proportion of high-acuity visits. The Wilcoxon rank-sum test was used to assess trends. Multivariable logistic regression was used to assess factors associated with ED admissions and proportions of high-acuity visits, as well as test the interaction between year and age group. RESULTS: Although the number of ED visits decreased from 108,838 in 2008 to 102,890 in 2019, the ED admission rate increased from 35.1% to 47.0%. Across all age groups, older adults aged ≥80 years showed a greater increase in ED admissions over time compared to adults aged 18-64 years. In the same period, the proportion of high-acuity ED visits increased across all age groups, although age-related differences diminished over time. Some fluctuations were observed in the most common ED diagnoses. CONCLUSION: Our study showed that ED admission rates, particularly among older adults, increased from 2008 to 2019. This highlights the growing care needs of older patients and underscore the importance of geriatric-friendly EDs and evidence-based programmes to ensure high-quality care.