The effects of cognitive impairment on nursing home residents' emergency department visits and hospitalizations

Background: Little is known about the relationship of cognitive impairment (CI) in nursing home (NH) residents and their use of emergency department (ED) and subsequent hospital services. Methods: We analyzed 2006 Medicare claims and resident assessment data for 112,412 Medicare beneficiaries aged >65 years residing in US nursing facilities. We estimated the effect of resident characteristics and severity of CI on rates of total ED visits per year, then estimated the odds of hospitalization after ED evaluation. Results: Mild CI predicted higher rates of ED visits relative to no CI, and ED visit rates decreased as severity of CI increased. In unadjusted models, mild CI and very severe CI predicted higher odds of hospitalization after ED evaluation; however, after adjusting for other factors, severity of CI was not significant. Conclusions: Higher rates of ED visits among those with mild CI may represent a unique marker in the presentation of acute illness and warrant further investigation. (C) 2014 The Alzheimer's Association. All rights reserved.