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Seniors Avoid ER at Start of Month

Researcher suggests they might want to avoid theft of Social Security checks

FRIDAY, April 4 (HealthDay News) -- A new study finds that senior citizens in Baltimore seem to avoid visiting the emergency room around the beginning of each month, possibly because they want to stay home and make sure no one steals their Social Security checks.

The findings could help doctors get a better handle on fluctuations in when the elderly seek medical care, said study author Dr. David Jerrard, an associate professor of emergency medicine at the University of Maryland. "We feel that this is a real phenomenon, a real trend."

Jerrard said he's noticed for some time that older patients were less likely to show up around the beginning of the month.

"Our patient load would drop off precipitously," he said. "Some of the patients would tell us that they'd made a point of staying home when their checks were sent out. A lot of them were fearful that the checks would be stolen."

In the new study, Jerrard and colleagues looked at two years of statistics about visits by people older than 62 to the emergency department of the Veterans Administration hospital in Baltimore.

They examined the number of patients who visited the center on 96 dates between December 2003 and November 2005. They didn't look at Sundays and holidays, when mail is not delivered.

The findings were expected to be released April 4 at the International Conference on Emergency Medicine in San Francisco.

The researchers found that an average of 30 patients visited the ER during dates in the middle of the month, compared to just 23 patients for each of the two days at the beginning of the month, when Social Security checks typically arrive.

By contrast, there was hardly any change in the number of patients under the age of 62 visiting the ER on the other days of the month.

Jerrard and colleagues had previously reported that some patients postpone ER visits, because they want to watch sporting events.

Jerrard said he can't confirm that the patients avoided the ER because they feared their Social Security checks would be stolen. It's also not clear if the patients who stayed home suffered medical consequences, although Jerrard plans to study that issue.

Many patients wouldn't be in danger by waiting a few hours or a couple days, he said. "But we'd be concerned about patients trying to struggle through a couple days of chest pain, or if they're sitting around with abdominal pain trying to tough it out."

Dr. James S. Goodwin, director of the Sealy Center on Aging at the University of Texas Medical Branch, said the study is "clever" and appears valid.

"Physicians and others caring for low-income elderly are well aware of the Social Security check phenomenon," he said. "Older people living in certain low-income neighborhoods have a realistic fear of crime. They want to be there when the check comes, so they can get it cashed and pay what they owe, but also because of the fear that someone else might take it. I would imagine that any other routine activity was also much less likely to occur in those first two days of the month, whether it was shopping, or getting a haircut, or something more important like going to the ER."

Direct deposit to a bank could be a solution, Goodwin said, but poor seniors may mistrust banks or not have an account.

In other developments reported at the International Conference on Emergency Medicine, University of Rochester researchers reported that seniors who spend more than six hours in the ER are much less likely to be discharged than others. Another study from Michigan researchers reported that about 19 percent of seniors who come to the ER from home are discharged to a nursing home.

More information

Learn about direct-deposit Social Security checks from the federal government.

SOURCES: David Jerrard, M.D., associate professor, emergency medicine, University of Maryland, Baltimore; James S. Goodwin, M.D., George and Cynthia Mitchell Distinguished Chair in Geriatric Medicine, and director, Sealy Center on Aging, University of Texas Medical Branch, Galveston; April 4, 2008, presentations, International Conference on Emergency Medicine, San Francisco

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