Cognitive health and risk of ED revisit in underserved older adults

The objective was to examine associations between cognitive health and unplanned emergency department (ED) revisits 30, 60, and 90 days after the initial visit.

Sociodemographic, clinical, and cognitive measures were collected on 110 white and African American adults, 65 years and older, who sought care in an inner-city ED. The information was collected via face-to-face interviews and review of the electronic medical record. Returns to the study-site ED 30, 60, and 90 days later were identified through a search of the electronic medical record.

The sample was mostly female (70.9%) and African American (73.6%), with an average age of 75 years (SD = 7.4). About half (56.4%) had 12 or more years of formal schooling. The overall cognitive score of 17.5 (SD 5.1) was 4.5 points less than standardized norms for persons 65 years and older. Each 1-point increase in cognitive score was associated with 24% and 21% decreased odds of 60-day (odds ratio [OR] = 0.76; 95% confidence interval [CI], 0.57-1.00) and 90-day revisit to the ED (OR = 0.79; 95% CI, 0.62-0.99), respectively. Cognitive health and odds of 30-day revisit (OR = 0.96; 95% CI, 0.72-1.26) had a nonsignificant association.

Our sample of older, mostly female African Americans showed poorer cognitive health compared with standardized norms. However, higher cognitive health scores were linked to lower risk for unplanned ED revisit 60 and 90 days later. A clearer understanding of biological and nonbiological pathways that connect cognitive health to revisit risk in disadvantaged older populations might improve health outcomes, including the avoidance of return trips to the ED.