title: The effects of cognitive impairment on nursing home residents' emergency department visits and hospitalizations.
abstract: BACKGROUND
  Little is known about the relationship of cognitive impairment (CI) in nursing home (NH) residents and their use of emergency department (ED) and subsequent hospital services.
  
  
  METHODS
  We analyzed 2006 Medicare claims and resident assessment data for 112,412 Medicare beneficiaries aged >65 years residing in US nursing facilities. We estimated the effect of resident characteristics and severity of CI on rates of total ED visits per year, then estimated the odds of hospitalization after ED evaluation.
  
  
  RESULTS
  Mild CI predicted higher rates of ED visits relative to no CI, and ED visit rates decreased as severity of CI increased. In unadjusted models, mild CI and very severe CI predicted higher odds of hospitalization after ED evaluation; however, after adjusting for other factors, severity of CI was not significant.
  
  
  CONCLUSIONS
  Higher rates of ED visits among those with mild CI may represent a unique marker in the presentation of acute illness and warrant further investigation.
authors.affiliation: Department of Community Health Systems, UCSF School of Nursing, San Francisco, CA, USA; Department of Social & Behavioral Sciences, UCSF School of Nursing, San Francisco, CA, USA. Electronic address: Caroline.stephens@ucsf.edu.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Stephens
authors.affiliation: Department of Social & Behavioral Sciences, UCSF School of Nursing, San Francisco, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Newcomer
authors.affiliation: Department of Community Health Systems, UCSF School of Nursing, San Francisco, CA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Blegen
authors.affiliation: Department of Neurology, UCSF School of Medicine, San Francisco, CA, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Miller
authors.affiliation: Department of Social & Behavioral Sciences, UCSF School of Nursing, San Francisco, CA, USA.
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D014481:United States
keywords: Cognitive impairment; Dementia; Emergency department; Health-care utilization; Hospitalization; Nursing home; Palliative care; Transitions in care