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Veterans With Dementia Face Extended Time Away From Home After Emergency Department Care
TOPLINE:
Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
- The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.
TAKEAWAY:
- Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
- ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
- Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
- Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).
IN PRACTICE:
"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."
SOURCE:
The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.
LIMITATIONS:
The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.
DISCLOSURES:
The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
- The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.
TAKEAWAY:
- Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
- ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
- Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
- Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).
IN PRACTICE:
"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."
SOURCE:
The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.
LIMITATIONS:
The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.
DISCLOSURES:
The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.
METHODOLOGY:
- Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
- The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.
TAKEAWAY:
- Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
- ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
- Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
- Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).
IN PRACTICE:
"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."
SOURCE:
The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.
LIMITATIONS:
The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.
DISCLOSURES:
The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Veterans With Dementia Face Extended Time Away From Home After Emergency Department Care
Veterans With Dementia Face Extended Time Away From Home After Emergency Department Care