title: Functional Decline Predicts Emergency Department Use in Veterans With Dementia.
abstract: BACKGROUND
  We examined emergency room (ER) utilization by persons with dementia (PWDs) using caregiver and patient characteristics as predictors.
  
  
  METHODS
  A secondary analysis of 296 veteran-caregiver dyads. Caregivers recorded PWD baseline characteristics and noted ER visits over the next year. Two sets of regression models analyzed categorical ER use and repeat ER use.
  
  
  RESULTS
  In the univariate analysis, categorical use of the ER was predicted by patients' functional status (P ≤ .008) and Veterans Affairs priority grouping (P ≤ .02). Repeat ER admissions were predicted by functional status (P ≤ .04), number of chronic conditions (P ≤ .01), and caregiver-reported relationship strain (P ≤ .04). In multivariate analysis, categorical ER use was predicted by functional status (P ≤ .02), priority grouping (P ≤ .03), and number of chronic conditions (P ≤ .06).
  
  
  CONCLUSIONS
  Functional status most strongly predicted ER use, highlighting the promise of home-based interventions to improve activities of daily living. Number of chronic conditions and caregiver-reported relationship strain are potential targets of intervention during discharge process.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ng
authors.affiliation: Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Walder
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jonmenjoy
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Margaret Blenkner Research Institute, Benjamin Rose Institute, Cleveland, OH, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Bass
authors.affiliation: Department of Psychology, Cleveland State University, Cleveland, OH, USA.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Judge
authors.affiliation: Center for Mental Health and Aging, University of Alabama, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA.
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA VA South Central Mental Illness Research, Education and Clinical Center, USA mkunik@bcm.edu.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D003704:Dementia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014728:Veterans / Q000706:statistics & numerical data*
keywords: activities of daily living; dementia; emergency; health services research; medical services