Comorbid conditions and emergency department treat and release utilization in multimorbid persons with cognitive impairment
Open accessAbstract
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.
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Having depression, rheumatoid arthritis or osteoarthritis was associated with higher emergency department use in Medicare beneficiaries with possible or probable dementia and two or more other chronic conditions.
“A third research team found that having depression, rheumatoid arthritis or osteoarthritis was associated with higher emergency department use in Medicare beneficiaries with possible or probable dementia and two or more other chronic conditions. 954”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [954]
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- Authors
- MacNeil-Vroomen, J. L., Nagurney, J. M., & Allore, H. G.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Yale University (US)
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 38
- Issue
- 1
- Pages
- 127-131
- ISSN
- 0735-6757 (ISSN-L)
- PMC
- PMC6917961
- OpenAlex
- W2959747811
- Cited by
- 22
- References
- 26
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 2
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Yale School of Medicine
- National Institute on Aging
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- multimorbidity, cognitive impairment, older adults, depression, osteoarthritis, rheumatoid arthritis, chronic disease, informal caregivers, emergency department utilization
- MeSH terms
- Multimorbidity, Facilities and Services Utilization, Activities of Daily Living, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Chronic Disease, Emergency Service, Hospital, Female, Medicare, Humans, Longitudinal Studies, Male, Osteoarthritis, United States, Cognitive Dysfunction
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