Comorbid conditions and emergency department treat and release utilization in multimorbid persons with cognitive impairment

Abstract

Background: There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization.

Methods: We examined the association of 16 chronic conditions on use of ED treat and release visit utilization among 1006 adults with cognitive impairment and ≥ 2 comorbidities using the nationally-representative National Health and Aging Trends Study merged with Fee-For-Service Medicare claims data, 2011-2015.

Results: At baseline, 28.5% had ≥6 conditions and 35.4% were ≥ 85 years old. After controlling for sex, age, race, education, urban-living, number of disabled activities of daily living, and sampling strata, we found significantly increased adjusted risk ratios (aRR) of ED treat and release visits for persons with depression (aRR 1.38 95% CI 1.15-1.65) representing 78/100 person-years, and osteoarthritis or rheumatoid arthritis (aRR 1.32 95% CI 1.12-1.57) representing 71/100 person-years. At baseline 93.9% had ≥1 informal caregiver and 69.7% had a caregiver that helped with medications or attended physician visits.

Conclusion: These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.

Keywords: Dementia; Emergency department and utilization; Longitudinal study; Multiple chronic conditions; National Health and Aging Trends study; Public health.

Figure 1:

Consort Diagram of Multimorbid Persons with Dementia Among Fee-For Service Medicare Beneficiaries in the National Health and Aging Trends Study in 2011 (n=1006).

Figure 2

Risk Ratios and Rates of Emergency Department Discharged Home for Multimorbid Persons with Dementia Among Fee-For Service Medicare Beneficiaries in the National Health and Aging Trends Study Data Linked with Medicare Claims, 2011–2015 The figure shows adjusted risk ratios from a weighted generalized estimating equations Poisson regression and rates. The regression model included all 16 chronic conditions, sex, age band, education, race, urban environment, count of disabled activities of daily living, sampling stratum variable and were weighted for drop out. * indicates that the marginal weighted estimate was significant at a Bonferroni corrected Type I error of p<0.003 and ** is a p<0.0001.