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Home Time Following Emergency Department Visits Among People With Dementia.
Justine Seidenfeld1,2, Lindsay Zepel3, Valerie A Smith3,4,5
1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina.
JAMA Network Open
|February 3, 2026
Summary
Emergency department (ED) visits for veterans with dementia significantly impact their time at home. Admission decisions and patient factors like frailty and housing status are key predictors of prolonged institutionalization after an ED visit.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Public Health
Background:
- Emergency department (ED) visits for individuals with dementia can have profound and lasting effects on their quality of life.
- Assessing the downstream outcomes of ED care for this population is crucial for improving patient-centered care.
- Home time, defined as days alive and outside of institutional care, offers a valuable metric for evaluating post-ED outcomes.
Purpose of the Study:
- To investigate variations in home time among veterans with dementia following an emergency department visit.
- To analyze the influence of patient, facility, and visit characteristics on home time outcomes.
- To identify factors associated with reduced home time after ED encounters in this demographic.
Main Methods:
- A national retrospective cohort study utilizing US Department of Veterans Affairs (VA) data.
- Inclusion of veterans aged 65–110 years with dementia experiencing an eligible VA ED visit in fiscal years 2017-2018.
- Analysis of home time (days not at home within 180 days post-ED visit) using a negative binomial model.
Main Results:
- The study analyzed 51,707 veterans with dementia, revealing a mean of 21.7 days not at home within 180 days post-ED visit.
- ED admission, compared to discharge, was the strongest predictor of increased days not at home (RR, 3.18).
- Patient factors such as high frailty, unhoused status, unmarried status, and depression were also significantly associated with more days not at home.
Conclusions:
- Home time serves as a patient-centered metric for evaluating the long-term impact of emergency department care for individuals with dementia.
- ED disposition decisions significantly influence post-visit outcomes, highlighting the need for careful consideration.
- Further research is warranted to refine the application of home time as a measure and to optimize ED care strategies for veterans with dementia.
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