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Background Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs. Objective This review aimed at identifying variables associated with frequent ED use by older adults. Methods For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence. A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community setting

Au Québec, la Durée Moyenne de Séjour (DMS) des patients dans les départements d’urgence dépasse 16 heures; une situation inacceptable par les patients, les équipes médicales et les administrateurs des hôpitaux. Ce phénomène d’encombrement des urgences est attribuable à divers facteurs souvent externes à ces départements. Afin de réduire le DMS aux urgences, cette thèse propose quatre contributions majeures. La première contribution consiste dans le développement de modèles de prévision des demandes de soins et d’hospitalisation selon un regroupement des patients par Catégories Majeures de Diagnostique (CMD). La deuxième contribution est la définition d’une nomenclature stochastique selon un regroupement des patients. Cette nomenclature permet de convertir la demande de soin dès l’étape de triage en besoin de ressources nécessaires pour répondre à cette demande. La troisième et la quatrième contribution sont l’analyse de l’effet du concept des cellules dynamiques appliqué aux salles d’examen et du Fast Track externe sur des indicateurs de performance du département d’urgence. Cette analyse utilise la modélisation simulatoire conjointement à des plans d’expérience. Cette thèse a contribué à l’avancement de la recherche par deux articles de revue avec comité de lecture et deux présentations de conférence avec comité de lecture. In Quebec, the average length of stay of patients in emergency departments exceeds 16 hours; an unacceptable situation for patients, medical teams and hospital administrators. This situation of overcrowding in emergency departments is attributed to various factors often external to these departments. In order to reduce the Length of stay in emergency departments, this thesis proposes four major innovations. The first innovation consists in the development of models for forecasting the emergency department visits and hospitalization according to a grouping of patients by Major Category of Diagnostic. The second innovation is the definition of a