Michael A LaMantia1, Kathleen A Lane2, Wanzhu Tu2, Jennifer L Carnahan3, Frank Messina4, Kathleen T Unroe3. 1. Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN. Electronic address: malamant@iu.edu. 2. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN. 3. Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN. 4. Indiana University School of Medicine, Indianapolis, IN.
Abstract
OBJECTIVES: To describe emergency department (ED) utilization among long-stay nursing home residents with different levels of dementia severity. DESIGN: Retrospective cohort study. SETTING: Public Health System. PARTICIPANTS: A total of 4491 older adults (age 65 years and older) who were long-stay nursing home residents. MEASUREMENTS: Patient demographics, dementia severity, comorbidities, ED visits, ED disposition decisions, and discharge diagnoses. RESULTS: Forty-seven percent of all long-stay nursing home residents experienced at least 1 transfer to the ED over the course of a year. At their first ED transfer, 36.4% of the participants were admitted to the hospital, whereas 63.1% of those who visited the ED were not. The median time to first ED visit for the participants with advanced stage dementia was 258 days, whereas it was 250 days for the participants with early to moderate stage dementia and 202 days for the participants with no dementia (P = .0034). Multivariate proportional hazard modeling showed that age, race, number of comorbidities, number of hospitalizations in the year prior, and do not resuscitate status all significantly influenced participants' time to first ED visit (P < .05 for all). After accounting for these effects, dementia severity (P = .66), years in nursing home before qualification (P = .46), and gender (P = .36) lost their significance. CONCLUSIONS: This study confirms high rates of transfer of long-stay nursing home residents, with nearly one-half of the participants experiencing at least 1 ED visit over the course of a year. Although dementia severity is not a predictor of time to ED use in our analyses, other factors that influence ED use are readily identifiable. Nursing home providers should be aware of these factors when developing strategies that meet patient care goals and avoid transfer from the nursing home to the ED.
OBJECTIVES: To describe emergency department (ED) utilization among long-stay nursing home residents with different levels of dementia severity. DESIGN: Retrospective cohort study. SETTING: Public Health System. PARTICIPANTS: A total of 4491 older adults (age 65 years and older) who were long-stay nursing home residents. MEASUREMENTS: Patient demographics, dementia severity, comorbidities, ED visits, ED disposition decisions, and discharge diagnoses. RESULTS: Forty-seven percent of all long-stay nursing home residents experienced at least 1 transfer to the ED over the course of a year. At their first ED transfer, 36.4% of the participants were admitted to the hospital, whereas 63.1% of those who visited the ED were not. The median time to first ED visit for the participants with advanced stage dementia was 258 days, whereas it was 250 days for the participants with early to moderate stage dementia and 202 days for the participants with no dementia (P = .0034). Multivariate proportional hazard modeling showed that age, race, number of comorbidities, number of hospitalizations in the year prior, and do not resuscitate status all significantly influenced participants' time to first ED visit (P < .05 for all). After accounting for these effects, dementia severity (P = .66), years in nursing home before qualification (P = .46), and gender (P = .36) lost their significance. CONCLUSIONS: This study confirms high rates of transfer of long-stay nursing home residents, with nearly one-half of the participants experiencing at least 1 ED visit over the course of a year. Although dementia severity is not a predictor of time to ED use in our analyses, other factors that influence ED use are readily identifiable. Nursing home providers should be aware of these factors when developing strategies that meet patient care goals and avoid transfer from the nursing home to the ED.
Authors: Kathleen T Unroe; Arif Nazir; Laura R Holtz; Helen Maurer; Ellen Miller; Susan E Hickman; Michael A La Mantia; Merih Bennett; Greg Arling; Greg A Sachs Journal: J Am Geriatr Soc Date: 2014-12-23 Impact factor: 5.562
Authors: Caroline E Stephens; Robert Newcomer; Mary Blegen; Bruce Miller; Charlene Harrington Journal: Alzheimers Dement Date: 2014-07-12 Impact factor: 21.566
Authors: Christopher M Callahan; Wanzhu Tu; Kathleen T Unroe; Michael A LaMantia; Timothy E Stump; Daniel O Clark Journal: J Am Geriatr Soc Date: 2015-07-22 Impact factor: 5.562
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Michael A LaMantia; Timothy E Stump; Frank C Messina; Douglas K Miller; Christopher M Callahan Journal: Alzheimer Dis Assoc Disord Date: 2016 Jan-Mar Impact factor: 2.703
Authors: Jennifer L Carnahan; James E Slaven; Christopher M Callahan; Wanzhu Tu; Alexia M Torke Journal: J Am Med Dir Assoc Date: 2017-06-21 Impact factor: 4.669
Authors: Tegveer S Uppal; Puneet Kaur Chehal; Gail Fernandes; J Sonya Haw; Megha Shah; Sara Turbow; Swapnil Rajpathak; K M Venkat Narayan; Mohammed K Ali Journal: JAMA Netw Open Date: 2022-05-02
Authors: Barbara Resnick; Kimberly Van Haitsma; Ann Kolanowski; Elizabeth Galik; Marie Boltz; Jeanette Ellis; Liza Behrens; Karen Eshraghi Journal: J Nurs Care Qual Date: 2021-11-12 Impact factor: 1.728
Authors: Luke Mondor; Colleen J Maxwell; David B Hogan; Susan E Bronskill; Andrea Gruneir; Natasha E Lane; Walter P Wodchis Journal: PLoS Med Date: 2017-03-07 Impact factor: 11.069
Authors: Tyler Kent; Adriane Lesser; Juhi Israni; Ula Hwang; Christopher Carpenter; Kelly J Ko Journal: J Am Geriatr Soc Date: 2019-08-12 Impact factor: 5.562