Bellolio, Fernanda

ABSTRACT Background One in five emergency department (ED) visits is by older adults aged 65+ years. Clinical practice guidelines are needed to optimize patient care by translating the best available evidence into actionable recommendations to guide person‐centered management for this medically complex and growing patient population. Our objective was to understand contributors' experiences and share best practices to inform other guideline working groups. Methods We conducted a qualitative study based on thematic analysis with an interpretivist paradigm in June–July 2025, using semi‐structured interviews of Geriatric Emergency Department (GED) Guidelines 2.0 contributors to understand their experiences. Interviews were transcribed, independently reviewed by team members, and reflexively coded to identify themes. Results We interviewed 18 participants. Four main themes emerged: (1) motivations for participation, (2) varying opportunities to be involved, (3) personal benefits, and (4) challenges for improvement. Participants contrasted the strengths of shared learning and development with the burdens of organization and coordination. Conclusion Contributors to the GED Guidelines 2.0 reported a positive experience. They joined because they wanted to contribute to better care of older patients and to achieve personal and professional goals. Many cited that their roles aligned with their strengths and expertise. They also gained skills and knowledge on systematic reviews and benefited from networking. Future groups planning a similar process should consider having multiple levels of leadership, experts in systematic reviews, regular reminders, and creative incentives to improve the process and foster improved networking opportunities within their disciplines.

Abstract Delirium is a state of acute confusion characterized by deficits in attention that occurs commonly in hospitalized older adults and is associated with adverse outcomes. Delirium may have significant implications for cognitive health, however the relationship of delirium to mild cognitive impairment (MCI) and dementia is not fully understood. To evaluate the impact of delirium on cognitive health trajectories, we leveraged the Mayo Clinic Study of Aging (MCSA), a population-based cohort study of cognitive health and aging in residents of Olmsted County, Minnesota, who are between the ages of 30 and 89 and without a previous diagnosis of dementia at enrollment. Emergency Department and hospital encounters were identified for all patients enrolled in the MCSA, and clinical notes following each encounter up to 30 days were analyzed using a previously validated natural language processing (NLP) algorithm for delirium detection. The association between delirium within 30 days of hospitalization and the development of MCI or dementia was assessed using Cox proportional hazards regression, adjusted for patient age, sex, and level of education. Initial MCSA assessment indicated normal cognition for all individuals in this cohort. We found that delirium was significantly associated with development of MCI and dementia, with 42 individuals experiencing delirium within 30 days of hospitalization; hazard ratio of 10.07 (95% CI 4.14, 24.49) for developing MCI and 19.10 (95% CI 8.40, 43.47) for dementia compared to those without delirium. Our results suggest that hospitalization with an episode of delirium can significantly impact cognitive trajectories in older adults.

Importance Emergency department (ED) visits for people with dementia often involve care (including the admission or discharge decision) with lasting effects on quality of life. Home time—a claims-based measure of days alive and outside of institutional care—provides a patient-centered way to assess downstream outcomes of ED care in this population. Objective To examine variations in home time following an ED visit by patient, facility, and visit characteristics among veterans with dementia. Design, Setting, and Participants This national retrospective cohort study used US Department of Veterans Affairs (VA) health care system data sources. Participants were veterans aged 65 to 110 years with dementia with an eligible Veterans Health Administration ED visit in fiscal years 2017 (October 1, 2016, through September 30, 2017) and/or 2018 (October 1, 2017, through September 30, 2018). Data were analyzed from May 1, 2024, to May 15, 2025. Exposures Patient, ED facility, and ED visit factors. Main Outcomes and Measures Home time, operationalized for modeling as days not at home in the 180 days after the index ED visit. Associations between patient, ED facility, and ED visit characteristics and home time were assessed using a negative binomial model. Results The study included 51 707 veterans with dementia (mean [SD] age, 79.9 [8.59] years; 97.6% male; 52.2% married). The mean (SD) number of days not at home within 180 days was 21.7 (34.5). Of the total cohort, 4.5% never returned home in the 180 days after their ED visit, while 18.2% had all subsequent days at home. ED admission (vs discharge) disposition was the factor associated with the largest increase in days not at home (rate ratio [RR], 3.18; 95% CI, 3.08-3.29). Patient factors associated with more days not at home included very high frailty (RR, 1.27; 95% CI, 1.21-1.33), unhoused status (RR, 1.50; 95% CI, 1.39-1.63), unmarried status (never married: RR, 1.24 [95% CI, 1.16-1.32]; divorced, separated, or widowed: RR, 1.24 [95% CI, 1.20-1.28]), and depression (RR, 1.13; 95% CI, 1.09-1.17). Conclusions and Relevance The findings of this cohort study suggest that home time offers a patient-centered measure of post-ED outcomes for individuals with dementia. Future work should refine its application, particularly regarding the ED disposition decision, to better evaluate the long-term impact of ED care decisions.

Abstract Background People living with dementia (PLWD) face short‐term risks following emergency department (ED) visits. However, the long‐term impacts of ED visits on PLWD quality of life are not well characterized. Home time‐ days alive and outside hospitals or other care settings‐ is an emerging measure that can reflect longer‐term outcomes. We aimed to identify patient and ED visit characteristics associated with variation in home time after an ED visit. Method Retrospective observational study of Veteran PLWD with ≥1 VA ED visit between 10/01/2016 and 09/30/2018. We used VA and CMS data sources to define veteran characteristics and outcomes. Primary outcome was home time in the 180 days after an ED visit, defined as days alive and not in an ED, inpatient, post‐acute, or a nursing home setting. We used a negative binomial model to evaluate the associations between covariates and home time with VAMC‐level random effects to account for correlation among patients at the same VAMC. Result Our final cohort comprised 51,707 Veteran PLWD, predominantly male (97.6%) and white (73.0%), with mean age 79.9 (SD 8.59). Most lived in urban areas (74.4%), and 52.2% were married. Characteristics associated with reduced home time included older age (RR 1.06, 95% CI 1.05‐1.07), never married (RR 1.24; 1.16‐1.32) or divorced/widowed (RR 1.24; 1.20, 1.28), depression (RR 1.13; 1.09, 1.17), and ED visits for chronic conditions (RR 1.13; 1.08, 1.18). Female sex (RR 0.88; 0.79‐0.97) and lower clinical frailty (RR 0.79; 0.75, 0.83) were associated with more home time. Conclusion Patient and ED visit characteristics impact home time up to 180 days after an ED visit. Older, frailer, unmarried, male patients and those presenting with chronic conditions experienced reduced home time, suggesting directions for targeted interventions. Efforts such as enhanced discharge planning and addressing psychosocial factors (e.g., depression) could improve quality of life.