Beyond Triage: Cognitive Profiles and ED-To-Inpatient Costs and Resource Pathways in Older Adults

Older adults are frequent users of the Emergency Department (ED), with a significant proportion presenting with pre-existing or acute cognitive impairment. While negative post-ED outcomes associated with cognitive status are well documented, their direct impact on care processes and resource allocation within the hospital remains poorly understood. This study aims to quantify how different cognitive profiles affect costs and care needs for acutely ill older adults.

We conducted a secondary analysis of a prospective cohort study at a single, tertiary care hospital. We included patients aged ≥ 65 years admitted to the hospital through the ED. They were stratified into three groups based on the brief Confusion Assessment Method (bCAM) and the 10-Point Cognitive Screener (10-CS): normal cognition, cognitive impairment without delirium, and delirium. Primary outcome was cost of care. Resource utilization, characterized by the number of medical specialties involved, geriatric consultation, type of inpatient bed allocated from the ED, time to hospitalization, and patient satisfaction, were explored as secondary outcomes. Multiple regression models were used to assess associations, adjusting for sociodemographic factors, clinical severity, and geriatric vulnerability.

The sample comprised 824 patients: 429 (52.1%) with normal cognition, 165 (20.0%) with delirium, and 230 (27.9%) with cognitive impairment without delirium. Clinical severity, but not cognitive status, was independently associated with costs (B = 0.18; 95% CI: 0.08, 0.27). Delirium was independently associated with allocation to high-complexity bed and receiving a geriatric consultation. Cognitive impairment was independently associated with a greater number of specialties involved.

Clinical severity showed the strongest association with costs. In contrast, cognitive profiles were independently associated with the care pathway and complexity, with delirium linked to higher-acuity allocation and preexisting cognitive impairment without delirium to broader multidisciplinary involvement. Recognizing these distinct cognitive profiles is fundamental for anticipating care demands and optimizing resource allocation for this vulnerable population.