Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 May;83(5):446-456.
doi: 10.1016/j.annemergmed.2023.09.022. Epub 2023 Dec 7.

Emergency Department Length of Stay for Older Adults With Dementia

Stephanie Nothelle  1 , Eric Slade  2 , Junyi Zhou  3 , Phillip D Magidson  4 , Tanya Chotrani  5 , Laura Prichett  3 , Halima Amjad  6 , Sarah Szanton  2 , Cynthia M Boyd  7 , Jennifer L Wolff  7
Affiliations
Observational Study

Emergency Department Length of Stay for Older Adults With Dementia

Stephanie Nothelle et al. Ann Emerg Med. 2024 May.

Abstract

Study objective: The emergency department (ED) poses unique challenges and risks to persons living with dementia. A longer ED length of stay is associated with the risk of death, delirium, and medication errors. We sought to determine whether ED length of stay differed by dementia status and trends in ED length of stay for persons living with dementia from 2014 to 2018 and whether persons living with dementia were at a higher risk for prolonged ED length of stay (defined as a length of stay > 90th percentile).

Methods: In this observational study, we used data from the Healthcare Cost and Utilization Project State Emergency Department Database from Massachusetts, Arkansas, Arizona, and Florida. We included ED visits resulting in discharge for adults aged ≥65 years from 2014 to 2018. We used inverse probability weighting to create comparable groups of visits on the basis of dementia status. We used generalized linear models to estimate the mean difference in ED length of stay on the basis of dementia status and logistic regression to determine the odds of prolonged ED length of stay.

Results: We included 1,039,497 ED visits (mean age: 83.5 years; 64% women; 78% White, 12% Hispanic). Compared with visits by persons without dementia, ED length of stay was 3.1 hours longer (95% confidence interval [CI] 3.0 to 3.3 hours) for persons living with dementia. Among the visits resulting in transfer, ED length of stay was on average 4.1 hours longer (95% CI 3.6 to 4.5 hours) for persons living with dementia. Visits by persons living with dementia were more likely to have a prolonged length of stay (risk difference 4.1%, 95% CI 3.9 to 4.4).

Conclusion: ED visits were more than 3 hours longer for persons living with versus without dementia. Initiatives focused on optimizing ED care for persons living with dementia are needed.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of observation inclusion and exclusion into study sample.
Figure 2.
Figure 2.
Adjusted mean emergency department length of stay by dementia status and year.
Figure 3.
Figure 3.
Adjusted mean emergency department (ED) length of stay by dementia status and transfer to facility.
See this image and copyright information in PMC

References

    1. Pines JM, Mullins PM, Cooper JK, et al. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc. 2013;61:12–17. - PubMed
    1. Feng Z, Coots LA, Kaganova Y, et al. Hospital and ED use among medicare beneficiaries with dementia varies by setting and proximity to death. Health Aff. 2014;33:683–690. - PubMed
    1. Gerson L, Counsell SR, Fontanarosa PB, et al. Case finding for cognitive impairment in elderly emergency department patients. Ann Emerg Med. 1994;23:813–817. - PubMed
    1. Hunt LJ, Coombs LA, Stephens CE. Emergency department use by community-dwelling individuals with dementia in the United States: an integrative review. J Gerontol Nurs. 2018;44:23–30. - PMC - PubMed
    1. Schumacher JG, Deimling GT, Meldon S, et al. Older adults in the emergency department: predicting physicians’ burden levels. J Emerg Med. 2006;30:455–460. - PubMed

Publication types