Caregiver Burden and 30-Day Emergency Department Revisits.

IMPORTANCE

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.

OBJECTIVE

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.

EXPOSURE

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).

MAIN OUTCOMES AND MEASURES

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.

RESULTS

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).

CONCLUSIONS AND RELEVANCE

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.