NCHS Data Brief ■ No. 130 ■ October 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Emergency Department Visits by Persons Aged 65 and Over: 

United States, 2009–2010

Michael Albert, M.D., M.P.H.; Linda F. McCaig, M.P.H.; and Jill J. Ashman, Ph.D.

From 2000–2010, the number of persons in the United States aged 65 and 

over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group 

represented 13% of the population (1). It is estimated that by 2030, nearly one 

in five persons will be aged 65 and over (2). Given their growing proportion 

of the population, older individuals will comprise an increasing share of 

emergency department (ED) patients in the coming years. This is important 

because of the ED’s role in treating acute illness and injury in older adults and 

providing a pathway to these patients for hospital admission (3,4). This report 

describes ED visits made by individuals aged 65 and over and compares age 

groups 65–74, 75–84, and 85 and over.

Keywords: health care utilization • older adults • National Hospital 

Ambulatory Medical Care Survey

How many ED visits were made by persons aged 65 and 

over, and did the visit rate increase with age?

• In 2009–2010, 19.6 million ED visits (15% of all ED visits) in the United 

States were made by patients aged 65 and over. (Figure 1).

Key findings

Data from the National 

Hospital Ambulatory 

Medical Care Survey, 

2009–2010

• In 2009–2010, a total of 19.6 

million emergency department 

(ED) visits in the United States 

were made by persons aged 65 

and over. The visit rate for this 

age group was 511 per 1,000 

persons and increased with age.

• The percentage of ED 

visits made by nursing home 

residents, patients arriving 

by ambulance, and patients 

admitted to the hospital 

increased with age.

• Twenty-nine percent of ED 

visits by persons aged 65 and 

over were related to injury, 

and the percentage was higher 

among those aged 85 and over 

than among those aged 65–74 

or 75–84.

• The percentage of ED visits 

caused by falls increased with 

age.

Figure 1. Number and rate of emergency department visits for persons aged 65 and over:

United States, 2009–2010

1

Linear trend shown is significant (p < 0.05) based on a weighted least-squares regression test. 

NOTES: Figures are based on 2-year averages. A sample of 10,279 emergency department visits were made by persons aged 65 

and over, representing an annual average weighted total of 19.6 million visits. Visit rates are based on the July 1, 2009, and July 1, 

2010, set of estimates of the civilian noninstitutionalized population of the United States as developed by the U.S. Census Bureau’s 

Population Division.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010. Number of visits in millions

Rate per 1,000 persons

5

0

10

15

20

25

511

398

573

19.6

8.3

7.2

4.1

Overall 65 and over 65–74 75–84 85 and over

100

300

500

700

1 900 832
NCHS Data Brief ■ No. 130 ■ October 2013

■  2  ■

• The annual average ED visit rate among persons aged 65 and over was 511 per 1,000 

persons and increased as age increased: 398 per 1,000 persons aged 65–74, 573 per 1,000 

persons aged 75–84, and 832 per 1,000 persons aged 85 and over.

What percentage of ED visits by older adults were made by nursing home 

residents, and did this percentage vary by age?

• In 2009–2010, nursing home residents accounted for 11.1% of ED visits made by patients 

aged 65 and over (Figure 2).

• As age increased, the percentage of ED visits made by nursing home residents also 

increased. Nursing home residents accounted for 4.6% of ED visits made by patients aged 

65–74, 12.3% of visits made by those aged 75–84, and 21.9% of visits made by those aged 

85 and over.

Figure 2. Percentage of emergency department visits by nursing home residents for persons aged 65 and over:

United States, 2009–2010 

1

Linear trend shown is significant (p < 0.05) based on a weighted least-squares regression test.

NOTES: Figures are based on 2-year averages. A sample of 1,151 emergency department visits were made by nursing home residents aged 65 and over, 

representing an annual average weighted total of 2.2 million visits.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

0

5

10

15

20

25

Percent of visits

Overall 65 and over 65–74 75–84 85 and over

11.1

4.6

12.3

1

21.9
NCHS Data Brief ■ No. 130 ■ October 2013

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What percentage of ED visits by older adults arrived by ambulance, and did 

this percentage vary by age?

• In 2009–2010, ambulance was the mode of arrival for 38.3% of all ED visits made by 

patients aged 65 and over (Figure 3).

• The percentage of ED visits where the patient arrived by ambulance increased with age: 

29.2% of visits by those aged 65–74, 39.5% by those aged 75–84, and 54.3% by those aged 

85 and over.

Figure 3. Percentage of emergency department visits arriving by ambulance for persons aged 65 and over:

United States, 2009–2010

1

Linear trend shown is significant (p < 0.05) based on a weighted least-squares regression test.

NOTES: Figures are based on 2-year averages. A sample of 3,887 emergency department visits were made by persons aged 65 and over arriving by ambulance, 

representing an annual average weighted total of 7.5 million visits.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

0

20

40

60

Percent of visits

Overall 65 and over 65–74 75–84 85 and over

38.3

29.2

39.5

1

54.3
NCHS Data Brief ■ No. 130 ■ October 2013

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What percentage of ED visits by older adults were caused by injury, and did 

this percentage vary by age?

• In 2009–2010, 29.1% of ED visits by persons aged 65 and over were related to injury

(Figure 4).

• The percentage of injury-related ED visits was higher among those aged 85 and over 

(33.4%) than among those aged 65–74 (28.2%) and 75–84 (27.8%).

• Unintentional falls accounted for 13.5% of ED visits by persons aged 65 and over.

• The percentage of ED visits caused by falls increased with age: 10.4% of ED visits by those 

aged 65–74, 13.2% by those aged 75–84, and 20.0% by those aged 85 and over.

Figure 4. Percentage of emergency department visits caused by any injury and by unintentional falls for persons aged 65 

and over: United States, 2009–2010

1

Percentage is significantly higher (p < 0.05) than for younger age groups, based on a two-tailed t test. 2

Linear trend shown is significant (p < 0.05) based on a weighted least-squares regression test.

NOTES: Unintentional falls were defined as first-listed external cause of injury codes 880–886 or 888 in the International Classification of Diseases, Ninth 

Revision, Clinical Modification (ICD–9–CM). Figures are based on 2-year averages. A sample of 3,066 emergency department (ED) visits caused by injury were 

made by patients aged 65 and over, representing an annual average weighted total of 5.7 million visits. A sample of 1,374 ED visits caused by falls were made 

by patients aged 65 and over, representing an annual average weighted total of 2.6 million visits.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010. Percent of visits

0

10

20

30

40

Visits caused by any injury Visits caused by falls

Overall 65 and over 65–74 75–84 85 and over

29.1 28.2

13.5

10.4

13.2

27.8

1

33.4

2

20.0
NCHS Data Brief ■ No. 130 ■ October 2013

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What percentage of ED visits by older adults led to hospitalization, and did 

this percentage vary by age?

• In 2009–2010, 36.5% of ED visits made by persons aged 65 and over resulted in hospital 

admission (Figure 5).

• The percentage of ED visits that resulted in hospital admission increased as age increased: 

32.4% of visits by those aged 65–74, 37.2% by those aged 75–84, and 43.4% by those aged 

85 and over.

Figure 5. Percentage of emergency department visits resulting in hospital admission for persons aged 65 and over: 

United States, 2009–2010

1

Linear trend shown is significant (p < 0.05) based on a weighted least-squares regression test.

NOTES: Figures are based on 2-year averages. A sample of 3,679 emergency department visits resulting in hospital admission were made by patients aged 65 and 

over, representing an annual average weighted total of 7.2 million visits. 

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

0

10

20

30

40

50

Percent of visits

Overall 65 and over 65–74 75–84 85 and over

36.5

32.4

37.2

1

43.4
NCHS Data Brief ■ No. 130 ■ October 2013

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Summary

This analysis examined ED visits made by persons aged 65 and over in 2009–2010 and identified 

a number of differences by age. The ED visit rate and the percentage of ED visits made by 

nursing home residents, patients arriving by ambulance, and patients admitted to the hospital 

increased with age. The percentage of injury-related ED visits was highest among persons aged 

85 and over, and the percentage of visits caused by a fall increased with age. As the proportion of 

older individuals in the United States continues to rise, the recognition of age differences in the 

utilization and provision of ED services among this population will be important.

Definitions

Emergency department (ED): A hospital facility that provides unscheduled outpatient services to 

patients whose conditions require immediate care, and is staffed 24 hours a day. Onsite and offsite 

EDs that are open fewer than 24 hours are included, if staffed by the hospital.

Emergency department visit: Direct, in-person exchange between a patient seeking ED care and a 

health care provider.

Injury-related visit: A visit that met one of the following three conditions: a “yes” was marked in 

response to the question, “Is this visit related to an injury, poisoning, or adverse effect of medical 

treatment?”; a cause of injury or a nature of injury diagnosis was provided; or an injury-related 

reason for visit was reported.

Data source and methods

Data for this analysis are from the National Hospital Ambulatory Medical Care Survey 

(NHAMCS), an annual, nationally representative survey of nonfederal, general, and shortstay hospitals. NHAMCS is conducted by the Centers for Disease Control and Prevention’s 

(CDC) National Center for Health Statistics and provides data on the utilization and provision 

of ambulatory care services in hospital emergency and outpatient departments (5,6). NHAMCS 

uses a multistage probability design with samples of geographic primary sampling units (PSUs), 

hospitals within PSUs, and patient visits within EDs. Each year, approximately 480 hospitals are 

selected for inclusion in NHAMCS, and data are collected on approximately 35,000 ED visits. 

Additional information on the methodology of NHAMCS has been described previously (5,6). 

Data were imputed for patient age. Proportions for nonimputed variables are based on totals that 

include unknown and blank responses.

Visits were considered to have been caused by an unintentional fall if they had a first-listed 

external cause of injury code of 880–886 or 888 from the International Classification of Diseases, 

Ninth Revision (ICD–9–CM) (7). Data analyses were performed using the statistical packages 

SAS, version 9.3 (SAS Institute, Cary, N.C.) and SAS-callable SUDAAN, version 10.0 (RTI 

International, Research Triangle Park, N.C.). A weighted least-squares regression analysis was 

used to test the significance of linear trends by age group (8). Differences in the percentage 

of injury-related visits between age groups in Figure 4 were evaluated using a two-tailed t

test. Comparisons reported in the text are statistically significant (p < 0.05), unless otherwise 

indicated.
NCHS Data Brief ■ No. 130 ■ October 2013

■  7  ■

About the authors

Michael Albert, Linda F. McCaig, and Jill J. Ashman are with CDC’s National Center for Health 

Statistics, Division of Health Care Statistics, Ambulatory and Hospital Care Statistics Branch.

References

1. Werner CA. The older population: 2010. Census brief C2010BR–09. U.S. Census Bureau: 

Washington, DC. 2011.

2. Vincent GK, Velkoff VA. The next four decades: The older population in the United States: 

2010 to 2050. Current population reports P25–1138. U.S. Census Bureau: Washington, DC. 2010.

3. Hwang U, Morrison RS. The geriatric emergency department. J Am Geriatr Soc 55(11):1873–

6. 2007.

4. Wang HE, Shah MN, Allman RM, Kilgore M. Emergency department visits by nursing home 

residents in the United States. J Am Geriatr Soc 59(10):1864–72. 2011.

5. National Center for Health Statistics. 2009 NHAMCS micro-data file documentation. 

2009. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/

NHAMCS/doc09.pdf.

6. National Center for Health Statistics. 2010 NHAMCS micro-data file documentation. 

2010. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/

NHAMCS/doc2010.pdf.

7. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention, 

Centers for Medicare & Medicaid Services. International classification of diseases, ninth revision, 

clinical modification, 6th ed. DHHS Pub No. (PHS) 06–1260. 2006. Available from: http://www.

cdc.gov/nchs/icd/icd9cm.htm.

8. Gillum BS, Graves EJ, Kozak LJ. Trends in hospital utilization: United States, 1988–92. 

National Center for Health Statistics. Vital Health Stat 13(124). 1996.
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Suggested citation

Albert M, McCaig LF, Ashman JJ. 

Emergency department visits by persons 

aged 65 and over: United States, 2009–2010. 

NCHS data brief, no 130. Hyattsville, MD: 

National Center for Health Statistics. 2013.

Copyright information

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the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., Acting Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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