Emergency Department Admission Reduces Home Time for US Veterans With Dementia

Key Clinical Summary

• Emergency department (ED) admission vs discharge was associated with the largest reduction in home time within 180 days among US veterans with dementia.
• Frailty, unhoused status, unmarried status, and depression were independently associated with fewer days spent at home after an ED visit.
• Home time may serve as a patient-centered outcome to assess post-ED quality of life in veterans with dementia, though refinement is needed.

ED visits can have lasting consequences for older adults with dementia, particularly US military veterans who often have complex medical and social needs. A national retrospective cohort study using US Department of Veterans Affairs (VA) data evaluated “home time”—days alive and outside institutional care—after an ED visit to better understand downstream outcomes and factors associated with reduced time at home.

Study Findings

The study analyzed VA health system data for 51 707 veterans aged 65 to 110 years with dementia who had an eligible ED visit during fiscal years 2017 or 2018. The cohort had a mean age of 79.9 years, was predominantly male (97.6%), and just over half were married (52.2%).

Home time was operationalized as days not spent at home in the 180 days following the index ED visit. On average, veterans experienced 21.7 days not at home during this period. Notably, 4.5% of patients never returned home within 180 days, while 18.2% spent all subsequent days at home.

ED disposition emerged as the most influential factor. Veterans admitted from the ED had more than 3 times the rate of days not at home compared with those discharged (rate ratio [RR], 3.18; 95% CI, 3.08-3.29). Admitted patients also experienced substantial subsequent health care use after the initial ED episode.

Several patient-level characteristics were independently associated with increased days not at home. Very high frailty was linked to a 27% increase in days not at home (RR, 1.27; 95% CI, 1.21-1.33). Veterans who were unhoused had a 50% higher rate (RR, 1.50; 95% CI, 1.39-1.63). Being unmarried—whether never married or divorced, separated, or widowed—was associated with a 24% increase in days not at home. Depression was also associated with reduced home time (RR, 1.13; 95% CI, 1.09-1.17).

Clinical Implications

For clinicians caring for US veterans with dementia, these findings highlight the potential long-term impact of ED care decisions. Admission decisions, while often clinically necessary, may substantially reduce the amount of time patients spend at home, a key marker of quality of life for individuals with cognitive impairment.

Home time offers a patient-centered, claims-based outcome that aligns with goals of care commonly prioritized by patients and caregivers. Understanding which veterans are at greatest risk for prolonged institutional care may help guide shared decision-making, discharge planning, and early involvement of supportive services.

The associations with frailty, housing instability, marital status, and depression underscore the importance of addressing social determinants of health and mental health comorbidities. For VA clinicians, integrating geriatric assessment, social work, and mental health support into ED and post-ED care pathways may help mitigate reductions in home time.

The study authors note that “home time offers a patient-centered measure of post-ED outcomes for individuals with dementia,” emphasizing its relevance for evaluating quality of life after acute care decisions. They also highlight the need to refine this measure, particularly in relation to ED disposition, to better capture the long-term impact of admission versus discharge decisions within the VA health care system.

Conclusion

In a large national VA cohort, ED admission was the strongest predictor of reduced home time for veterans with dementia. Home time may provide clinicians with a meaningful, patient-centered outcome to assess post-ED quality of life and inform care decisions for this vulnerable population.

Reference

Seidenfeld J, Zepel L, Smith VA, et al. Home time following emergency department visits among people with dementia. JAMA Netw Open. 2025;8(12):e2549154. doi:10.1001/jamanetworkopen.2025.49154