Emergency Department Boarding for Older Adults: The Impact of Geography, Temporal Trends, and Dementia Status.
Academic Article
Overview
abstract
STUDY OBJECTIVE: Emergency department (ED) boarding, defined as the time an admitted patient remains in the ED awaiting an inpatient bed, has become a growing challenge in the United States, particularly for older adults with Alzheimer's disease-related dementia. We examined trends in ED boarding from 2015 to 2022, focusing on geographic variation, rurality, and differences by Alzheimer's disease-related dementia status. METHODS: We conducted a cross-sectional analysis using National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2015 to 2022. Adults aged ≥65 years who were admitted to the hospital were included. Weighted estimates characterized annual boarding rates (≥2, 4, and 8 hours). Linear probability models assessed associations of study year, region, rurality, and Alzheimer's disease-related dementia status with boarding as binary outcomes; linear regression examined boarding duration in minutes. RESULTS: Among an estimated 7.05 million eligible encounters, 4.45 million had complete data; 85.2% experienced boarding ≥2 hours. Rates remained in the mid-80% range from 2015 to 2018, dipped in 2017 and 2020, and rose to 92% in 2021 to 2022. Mean boarding time increased from 138 minutes (95% confidence interval [CI] 112 to 164) in 2018 to 343 minutes (95% CI 238 to 448) in 2022, reaching 501 minutes (95% CI -20 to 1,022) among patients with Alzheimer's disease-related dementia. Each additional calendar year was associated with a 3.2% increase in 4-hour boarding (95% CI 2.4% to 4.0%) and 15.3 more minutes of boarding time (95% CI 10.0 to 20.0). In the Alzheimer's disease-related dementia subgroup, boarding increased most among those aged ≥75 years and in metropolitan areas. CONCLUSION: Emergency department boarding among older adults has worsened over time, especially for those with Alzheimer's disease-related dementia. Regional disparities and disproportionate impacts on vulnerable populations highlight the urgent need for targeted policy and operational interventions.
