Germain Nathalie, Toulouse-Fournier Annie, Samb Rawane, Côté Émilie, Couture Vanessa, Turcotte Stéphane, Morin Michèle, Couturier Yves, Chartier Lucas B, Sourial Nadia, Sinha Samir K, Melady Don, Hardy Marie-Soleil, Fleet Richard, Légaré France, Roy Denis A, Witteman Holly O, Mercier Éric, Rivard Josée, Sirois Marie-Josée, Robitaille Joanie, Archambault Patrick M
Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada.
Faculté de médecine, Université Laval, Québec, Québec, Canada.
JAMA Netw Open. 2025 Sep 2;8(9):e2531166. doi: 10.1001/jamanetworkopen.2025.31166.
Caregivers of community-dwelling older adults play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue.
To develop models describing whether caregiver burden is associated with ED revisits and hospital admissions up to 30 days after discharge from an initial ED visit.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study nested within the LEARNING WISDOM longitudinal cohort study included dyads of community-dwelling patients aged 65 years or older and their caregivers. Included patients were triaged to an observation unit stretcher on their index visit to 1 of 4 EDs within an integrated health multisite organization of 4 acute care hospitals in Québec, Canada, between January 1, 2019, and December 21, 2021, and underwent a transition of care when discharged back to the community. Analyses were conducted in May 2024.
Caregiver burden, collected using the brief 12-item Quebec French version of the Zarit Burden Interview (ZBI; score range, 0-48, with higher scores indicating higher burden).
Revisits to the ED, defined as a return to any ED in the 4-hospital network, within 3, 7, or 30 days of the index visit and return visits to the ED resulting in hospitalization within 30 days of the index visit. Moderation of outcomes by wave of the COVID-19 pandemic at the index visit was also assessed.
Among 1409 caregiver-patient dyads, 711 patients (50.5%) and 980 caregivers (69.6%) were women; mean (SD) age was 77.06 (7.39) years for patients and 63.87 (12.04) years for caregivers. The mean (SD) ZBI score was 7.33 (7.11). Caregivers were most often spouses of patients (667 [48.0%]) or children of patients (534 [37.9%]). Among all patients, 75 (5.3%) returned to the ED within 3 days, 133 (9.4%) returned within 7 days, 292 (20.7%) returned within 30 days, and 88 (6.2%) were admitted to the hospital within 30 days. Each point increase on the ZBI scale was associated with an increase in the odds of a 30-day revisit to the ED (odds ratio [OR], 1.03; 95% CI, 1.00-1.05; P = .03), but associations were not found in models with shorter time windows (3 days: OR, 1.01; 95% CI, 0.98-1.04; P = .69; 7 days: OR, 1.01; 95% CI, 0.98-1.03; P = .55) or for revisits with hospital admissions (OR, 1.02; 95% CI, 0.99-1.05; P = .24). Associations between ZBI scores and 30-day ED revisits may have been moderated by the COVID-19 pandemic waves: the first interwave period (between waves 1 and 2) reversed the association (OR, 0.89; 95% CI, 0.78-0.97).
The findings suggest caregiver burden may be associated with ED revisits within 30 days of discharge from an initial ED visit among community-dwelling older adults. Future studies could enhance the management of ED revisits by demonstrating the longitudinal impact of caregiver burden on ED use in older adults.
社区居住的老年人的照料者在急诊科（ED）护理过渡中发挥着保护作用。当照料需求导致照料者负担时，可能会出现急诊科复诊情况。
建立模型，描述照料者负担是否与初次急诊科就诊出院后30天内的急诊科复诊和住院情况相关。
设计、地点和参与者：这项前瞻性队列研究嵌套在“学习智慧”纵向队列研究中，纳入了年龄在65岁及以上的社区居住患者及其照料者组成的二元组。纳入的患者在2019年1月1日至2021年12月21日期间，在加拿大魁北克省4家急性护理医院的综合健康多站点组织内的4家急诊科中的1家进行首次就诊时被分诊到观察单元担架上，出院返回社区时接受了护理过渡。分析于2024年5月进行。
使用12项简短的魁北克法语版 Zarit 负担访谈（ZBI；评分范围为0 - 48，分数越高表明负担越重）收集照料者负担。
复诊定义为在首次就诊后3天、7天或30天内返回4家医院网络中的任何急诊科，以及首次就诊后30天内因复诊导致住院。还评估了首次就诊时COVID - 19大流行波对结局的调节作用。
在1409对照料者 - 患者二元组中，711名患者（50.5%）和980名照料者（69.6%）为女性；患者的平均（标准差）年龄为77.06（7.39）岁，照料者为63.87（12.04）岁。ZBI评分的平均（标准差）为7.33（7.11）。照料者最常是患者的配偶（667人[48.0%]）或子女（534人[37.9%]）。在所有患者中，75人（5.3%）在3天内返回急诊科，133人（9.4%）在7天内返回，292人（20.7%）在30天内返回，88人（6.2%）在30天内入院。ZBI量表上每增加1分与30天内急诊科复诊几率增加相关（比值比[OR]，1.03；95%置信区间，1.00 - 1.05；P = 0.03），但在较短时间窗口的模型中未发现关联（3天：OR，1.01；95%置信区间，0.98 - 1.04；P = 0.69；7天：OR，1.01；95%置信区间，0.98 - 1.03；P = 0.55），对于复诊并住院的情况也未发现关联（OR，1.02；95%置信区间，0.99 - 1.05；P = 0.24）。ZBI评分与30天内急诊科复诊之间的关联可能受到COVID - 19大流行波的调节：第一个波间期（第1波和第2波之间）使该关联逆转（OR，0.89；95%置信区间，0.78 - 0.97）。
研究结果表明，照料者负担可能与社区居住的老年人初次急诊科就诊出院后30天内的急诊科复诊相关。未来的研究可以通过证明照料者负担对老年人急诊科使用的纵向影响来加强对急诊科复诊的管理。
