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Cited by 68Emergency and Acute Care StudiesDementia and Cognitive Impairment ResearchGeriatric Care and Nursing Homes

30‐Day Emergency Department Revisit Rates among Older Adults with Documented Dementia

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Kent, Tyler, Lesser, Adriane, Israni, Juhi, Hwang, Ula, Carpenter, Christopher, Ko, Kelly J.·2019·Journal of the American Geriatrics Society
DOI 10.1111/jgs.16114PMC PMC6899685
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Abstract

OBJECTIVES: Published literature on national emergency department (ED) revisit rates among older adults with dementia is sparse, despite anecdotal evidence of higher ED utilization. Thus we evaluated the odds ratio (OR) of 30‐day ED revisits among older adults with dementia using a nationally representative sample. DESIGN: We assessed the frequency of claims associated with a 30‐day ED revisit among Medicare beneficiaries with and without a dementia diagnosis before or at index ED visit. We used a logistic regression model controlling for dementia, age, sex, race, region, Medicaid status, transfer to a skilled nursing facility after ED, primary care physician use 12 months before index, and comorbidity. SETTING: A nationally representative sample of claims data for Medicare beneficiaries aged 65 and older who maintained continuous fee‐for‐service enrollment during 2015 and 2016. Only outpatient claims associated with an ED visit between January 2016 and November 2016 were included as a qualifying index encounter. PARTICIPANTS: We identified 240 249 patients without dementia and 54 622 patients for whom a dementia code was recorded in the year before the index encounter in 2016. RESULTS: Our results indicate a significant difference in unadjusted 30‐day ED revisit rates among those with an ED dementia diagnoses (22.0%) compared with those without (13.9%). Our adjusted results indicated that dementia is a significant predictor of 30‐day ED revisits ( P < .0001). Those with a dementia diagnosis at or before the index ED visit were more likely to have experienced an ED revisit within 30 days (OR = 1.27; 95% confidence interval = 1.24‐1.31). CONCLUSION: Dementia diagnoses were a significant predictor of 30‐day ED revisits. Further research should assess potential reasons why dementia is associated with markedly higher revisit rates, as well as opportunities to manage and transition dementia patients from the ED back to the community more effectively. J Am Geriatr Soc 67:2254–2259, 2019

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  • Fragmentation between health and social care contributed to reduced responsibility for healthcare professionals in emergency departments to support social and non-urgent needs, likely increasing the patient's risk of under-triage.

    “Additionally, fragmentation between health and social care contributed to reduced responsibility for HCPs in emergency departments to support social and non-urgent needs, likely increasing the patient’s risk of under-triage (CMOC13) [47, 49, 56, 60, 76, 77, 82, 90, 93, 94].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [94]

    The Discussion (page not provided) describes a potential role for ED clinicians in care transitions and connecting dementia patients with social resources. It does not address fragmentation between health and social care, reduced professional responsibility, or a resulting risk of under-triage; searches for those terms and non-urgent needs found no supporting passage. (LLM, conf=0.76)

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  • Community-dwelling older adults living with dementia are at high risk for repeated emergency department visits.

    “Community-dwelling older adults living with dementia are at high risk for repeated emergency department (ED) visits.[13][14][15]”

    From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [15]

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Authors
Kent, T., Lesser, A., Israni, J., Hwang, U., Carpenter, C., & Ko, K. J.
Affiliations
  • West Health (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Washington University in St. Louis (US)
Corresponding author
Kent, Tyler
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2019-08-12
Volume
67
Issue
11
Pages
2254-2259
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.16114
PMC
PMC6899685
OpenAlex
W2968664280
Cited by
68
References
36
Citations by year
2026: 5 · 2025: 13 · 2024: 10 · 2023: 17 · 2022: 15 · 2021: 4 · 2020: 4
FWCI
6.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Geriatrics Society (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords
dementia, emergency department revisits, older adults, emergency department utilization, Medicare beneficiaries, transition to community care, comorbidities
MeSH terms
Aged, Aged, 80 and over, Dementia, Emergency Service, Hospital, Female, Medicare, Humans, Male, Patient Readmission, Patient Transfer, Retrospective Studies, United States, Incidence, Fee-for-Service Plans

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