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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated
Victoria P Schulte1, Cristina Guasch2, Angela Landerholm3
1Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, Massachusetts.
The Western Journal of Emergency Medicine
|June 8, 2026
Summary
Prolonged emergency department (ED) boarding for older adults awaiting psychiatric hospitalization is common and linked to increased functional decline and physical restraint. Addressing psychiatric capacity is crucial for this vulnerable population.
Area of Science:
- Geriatric Psychiatry
- Emergency Medicine
- Health Services Research
Background:
- Older adults increasingly face psychiatric emergencies in emergency departments (EDs).
- Limited inpatient psychiatric capacity leads to prolonged ED boarding for geriatric patients.
- This study investigates the impact of extended ED boarding on older adults awaiting psychiatric care.
Purpose of the Study:
- To quantify ED boarding duration for older adults needing psychiatric hospitalization.
- To examine the association between prolonged boarding and functional decline.
- To assess the link between extended ED stays and physical restraint use in this demographic.
Main Methods:
- Retrospective cohort study of adults aged 65+ in two community EDs (Jan 2023-June 2024).
- Behavioral health evaluations conducted by emergency services program (ESP) clinicians.
- Primary outcome: boarding duration (bed search initiation to departure/clearance); Secondary outcomes: functional decline and physical restraint.
Main Results:
- Over half (53.9%) of 334 encounters boarded for ≥ 24 hours, with a median boarding time of 44 hours.
- Functional decline occurred in 12.6% and restraint in 8.1%, exclusively in patients boarding ≥ 24 hours.
- Patients with neurocognitive disorders showed significantly higher rates of functional decline and restraint.
Conclusions:
- Prolonged ED boarding for older adults awaiting psychiatric care is frequent in community settings.
- Extended boarding is associated with increased risk of functional decline and physical restraint.
- Findings highlight the need for improved psychiatric capacity to mitigate adverse outcomes for geriatric patients.
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