Geriatric Emergency Management Programs and Days at Home Among People Living With Dementia in Ontario

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Abstract
Background: People living with dementia frequently present to emergency departments (EDs) and are at increased risk of hospitalization, institutionalization, and other adverse outcomes. Geriatric Emergency Management (GEM) programs are designed to improve emergency care for older adults, but their effectiveness among people living with dementia remains uncertain. We evaluated the association between attendance at an ED with an active GEM program and days alive and at home among older adults living with dementia. Methods: We conducted a population‐based retrospective cohort of Ontario residents aged 65 years or older with identified dementia who had an index ED visit between April 1, 2021, and March 31, 2024. The exposure was attendance at an ED with an active GEM program. Results: The cohort included 145,874 individuals, including 110,288 who presented to EDs with GEM programs and 35,586 who presented to EDs without GEM programs. The median age of the population was 81 years and 58.5% of participants were female. After propensity score overlap weighting and adjustment for facility characteristics, individuals who visited GEM EDs spent 7.5 (95% CI, 3.1–12.0) more days alive and at home during the following year than those who visited non‐GEM EDs. Approximately half of this difference was attributable to fewer days spent in long‐term care homes. Visits to GEM EDs were also associated with fewer subsequent ED visits, although index ED length of stay and hospital admission rates were higher. Conclusions and Relevance: Among older adults living with dementia, care in EDs with GEM programs was associated with more days alive at home over the following year. These findings support continued investment in GEM programs to promote aging at home and to delay institutionalization among people living with dementia.
Funding Information
  • Alzheimer Society (0000000049)
  • Research Institute for Aging, University of Waterloo
  • University of Toronto

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