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Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis

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Abstract

Objective

Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis.

Methods

We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30 days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I2 statistic and considered \({I}^{2}\) > 50% to indicate substantial heterogeneity. All analyses were performed in R software.

Results

We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5 years or greater) and 18.9% (5 years or less).

Conclusion

Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.

Résumé

Objectifs

Les personnes âgées se rendent aux services d'urgence (SU) à des taux plus élevés que leurs homologues plus jeunes. Cependant, on sait moins à quelle fréquence les personnes âgées vivant avec une démence se rendent et retournent aux SU. Nous avons mené une revue systématique et une méta-analyse pour quantifier le taux de retour aux SU chez les personnes âgées vivant avec un diagnostic de démence.

Méthodes

Nous avons effectué une recherche dans MEDLINE, Embase et CINAHL, ainsi que dans la littérature grise, pour identifier les études observationnelles rapportant sur les personnes âgées vivant avec une démence qui sont retournées aux SU dans les 30 jours suivant une visite antérieure aux SU. Nous avons calculé les taux de retour à 30 jours en pourcentage en utilisant des modèles à effets aléatoires, et nous avons effectué des analyses stratifiées selon la source des données de l'étude, la population de l'étude et la période de l'étude. Nous avons évalué l'hétérogénéité entre les études à l'aide de la statistique I2 et avons considéré I^2 > 50 % comme indicateur d'une hétérogénéité substantielle. Toutes les analyses ont été réalisées dans le logiciel R.

Résultats

Nous avons identifié six articles à inclure. Les pourcentages de retour aux SU à 30 jours chez les personnes âgées vivant avec une démence variaient largement de 16,1 % à 58,0 %. Le taux global de retour de 28,6 % présentait une hétérogénéité significative. L'hétérogénéité entre les études dans toutes les analyses stratifiées était également élevée. Selon la source des données, les pourcentages de retour à 30 jours étaient de 52,3 % (hôpitaux publics) et de 20,0 % (bases de données administratives) ; selon la population de l'étude, les pourcentages de retour étaient de 33,5 % (démence comme population principale) et de 19,8 % (démence comme sous-groupe) ; selon la période de l'étude, les pourcentages de retour étaient de 41,2 % (5 ans ou plus) et de 18,9 % (5 ans ou moins).

Conclusion

La littérature existante sur les retours aux SU chez les personnes âgées vivant avec une démence met en évidence les complexités médicales et les défis liés au congé et aux soins de suivi qui peuvent amener ces patients à recourir aux SU à un taux accru. Le personnel des SU peut jouer un rôle important dans la mise en relation des patients et des aidants avec des ressources médicales et sociales plus appropriées afin de proposer une approche des soins plus efficace et plus complète.

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Data availability

All data generated or analyzed during this study are included in this published article and the supplemental file.

References

  1. Griffith LE, Gruneir A, Fisher K, Panjwani D, Gandhi S, Sheng L, et al. Patterns of health service use in community living older adults with dementia and comorbid conditions: a population-based retrospective cohort study in Ontario. Canada BMC Geriatr. 2016;16(1):1–10.

    Google Scholar 

  2. Rice DP, Fillit HM, Max W, Knopman DS, Lloyd JR, Duttagupta S. Prevalence, costs, and treatment of Alzheimer’s disease and related dementia: a managed care perspective. Am J Manag Care. 2001;7(8):809–18.

    CAS  PubMed  Google Scholar 

  3. Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, et al. Comorbidity and dementia: A scoping review of the literature. BMC Med. 2014; 12 (1).

  4. Franchi C, Cartabia M, Santalucia P, Baviera M, Mannucci PM, Fortino I, et al. Emergency department visits in older people: pattern of use, contributing factors, geographical differences and outcomes. Aging Clin Exp Res. 2017;29:319–26.

    Article  PubMed  Google Scholar 

  5. Alzheimer’s Association. World’s Alzheimers’s Report. 2017 Alzheimer’s disease facts and figures. 2017;13: 325–373.

  6. Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307(2):165–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Luengo-Fernandez R, Leal J, Gray AM. Cost of dementia in the pre-enlargement countries of the European union. J Alzheimer’s Dis. 2011;27(1):187–96.

    Article  Google Scholar 

  8. Gutterman EM, Markowitz JS, Lewis B, Fillit H. Cost of Alzheimer’s disease and related dementia in managed-medicare. J Am Geriatr Soc. 1999;47(9):1065–71.

    Article  CAS  PubMed  Google Scholar 

  9. LaMantia MA, Lane KA, Tu W, Carnahan JL, Messina F, Unroe KT. Patterns of emergency department use among long-stay nursing home residents with differing levels of dementia severity. J Am Med Dir Assoc. 2016;17(6):541–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bass DM, Judge KS, Maslow K, Wilson NL, Morgan RO, McCarthy CA, et al. Impact of the care coordination program “partners in dementia care” on veterans’ hospital admissions and emergency department visits. Alzheimer’s Dement Transl Res Clin Interv. 2015;1(1):13–22.

    Article  Google Scholar 

  11. Lowthian J, Curtis A, Stoelwinder J, McNeil J, Cameron P. Emergency demand and repeat attendances by older patients. Intern Med J. 2013;43(5):554–60.

    Article  CAS  PubMed  Google Scholar 

  12. Segal-Gidan F. Dementia and the ER - A toxic combination. Ann Long-Term Care. 2018; 26 (4).

  13. Baum SA, Rubenstein LZ. Old People in the emergency room: Age-related differences in emergency department use and care. J Am Geriatr Soc. 1987;35(5):398–404.

    Article  CAS  PubMed  Google Scholar 

  14. Lowenstein SR, Crescenzi CA, Kern DC, Steel K. Care of the elderly in the emergency department. Ann Emerg Med. 1986;15(5):528–35.

    Article  CAS  PubMed  Google Scholar 

  15. Shaw JA, Stiliannoudakis S, Qaiser R, Layman E, Sima A, Ali A. Thirty-day hospital readmissions: A predictor of higher all-cause mortality for up to two years. Cureus. 2020;12(7): e9308.

    PubMed  PubMed Central  Google Scholar 

  16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Covidence. Covidence - Better systematic review management. https://www.covidence.org/. Accessed 20 Oct 2022.

  18. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 5 Oct 2022.

  19. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  20. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327(7414):557–60.

    Article  Google Scholar 

  21. The R Foundation. The R project for statistical computing. 2022. https://www.r-project.org/. Accessed 20 Oct 2022.

  22. Jorgensen S, Zurayk M, Yeung S, Terry J, Dunn M, Nieberg P, et al. Risk factors for early return visits to the emergency department in patients with urinary tract infection. Am J Emerg Med. 2018;36(1):12–7.

    Article  PubMed  Google Scholar 

  23. Kent T, Lesser A, Israni J, Hwang U, Carpenter C, Ko KJ. 30-day emergency department revisit rates among older adults with documented dementia. J Am Geriatr Soc. 2019;67(11):2254–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. LaMantia MA, Stump TE, Messina FC, Miller DK, Callahan CM. Emergency department use among older adults with dementia. Alzheimer Dis Assoc Disord. 2016;30(1):35–40.

    Article  PubMed  PubMed Central  Google Scholar 

  25. e Silva LOJ, Jeffery MM, Campbell RL, Mullan AF, Takahashi PY, Bellolio F. Predictors of return visits to the emergency department among different age groups of older adults. Am J Emerg Med. 2021; 46: 241–246.

  26. Gettel CJ, Merchant RC, Li Y, Long S, Tam A, Marks SJ, et al. The impact of incomplete nursing home transfer documentation on emergency department care. J Am Med Dir Assoc. 2019;20(8):935–41.

    Article  PubMed  Google Scholar 

  27. Jones A, Maclagan LC, Watt JA, Schull MJ, Jaakkimainen L, Swayze S, et al. Reasons for repeated emergency department visits among community-dwelling older adults with dementia in Ontario. Canada J Am Geriatr Soc. 2022;70(6):1745–53.

    Article  PubMed  Google Scholar 

  28. Gruneir A, Bell CM, Bronskill SE, Schull M, Anderson GM, Rochon PA. Frequency and pattern of emergency department visits by long-term care residents - A population-based study. J Am Geriatr Soc. 2010;58(3):510–7.

    Article  PubMed  Google Scholar 

  29. Naseer M, Agerholm J, Fastbom J, Schön P, Ehrenberg A, Dahlberg L. Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study. Arch Gerontol Geriatr. 2020;86: 103960.

    Article  PubMed  Google Scholar 

  30. Canadian Institute for Health Information. Ambulatory Care Sensitive Conditions. https://www.cihi.ca/en/indicators/ambulatory-care-sensitive-conditions. Accessed 27 Mar 2023.

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Acknowledgements

We thank our librarian, Heather Ganshorn, for her assistance in developing our search strategy. We also thank Joel Adekanye, and Drs. Alexander Leung and Karen Tang for their direction and support.

Funding

Authors did not received any funding for this work.

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services – Calgary zone, Calgary, AB, Canada

    Dana Jelinski, Olayinka I. Arimoro, Caley Shukalek, Krista Reich, Jayna Holroyd-Leduc & Zahra Goodarzi

  2. Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services – Calgary zone, Calgary, AB, Canada

    Caley Shukalek, Krista Reich, Jayna Holroyd-Leduc & Zahra Goodarzi

  3. Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada

    Kayla R. Furlong

  4. Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada

    Kayla R. Furlong

  5. Department of Emergency Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services – Calgary zone, Calgary, AB, Canada

    Eddy Lang

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  1. Dana Jelinski
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  2. Olayinka I. Arimoro
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Corresponding author

Correspondence to Dana Jelinski.

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Conflict of interest

KRF has received funding from the Canadian Association of Emergency Physicians, as well as the Carbonear Institute for Rural Reach and Innovation by the Sea. KRF is a Canadian Association of Emergency Physicians Geriatric Emergency Medicine committee member. KRF is also the Geriatric Emergency Medicine Research Lead for the Geriatric Emergency Medicine Working Group, Eastern Health, Newfoundland and Labrador, Canada. OIA is a First Year Representative for the Community Health Sciences Students’ Executive at the University of Calgary, Canada.

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Additional information

Communicated by Audrey-Anne Brousseau.

Supplementary Information

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Supplementary file1 (DOCX 278 KB)

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Jelinski, D., Arimoro, O.I., Shukalek, C. et al. Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis. Can J Emerg Med 25, 884–892 (2023). https://doi.org/10.1007/s43678-023-00578-z

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  • DOI: https://doi.org/10.1007/s43678-023-00578-z

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