Abstract Introduction The rapidly aging population and multimorbidity are associated with increased emergency department (ED) visits by older adults. In the ED, older adults have higher risk of hospitalization, functional and cognitive decline, and mortality. Boarding, holding admitted patients in the ED awaiting a hospital bed, exacerbates these negative outcomes, which disproportionately affect older adults. Methods We conducted a cross-sectional analysis to investigate US boarding trends by age using clinical administrative data from 5 health systems and publicly available NHAMCS data from 2018-2024. Results Boarding ≥3 hours in the ED has increased across diverse hospital types, with oldest adults (85+) facing the greatest risk (System 4: IRR 95% CI = 1.18 1.15-1.20, System 5: IRR 95% CI = 1.20 1.17-1.23, System 3 Community Hospital: IRR 95% CI = 1.25 1.19-1.33). These results were recapitulated at the national level in NHAMCS (IRR 95% CI = 1.30 1.05-1.61). Discussion The trend of increased boarding has serious implications for patients, caregivers, and health systems. The 2025 CMS Age-Friendly Hospital Measure offers opportunities to improve processes and procedures to mitigate the negative effects of hospital boarding on older patients. We highlight opportunities to address this challenge, including ongoing quality improvement initiatives, bed prioritization algorithms, and alternate admission pathways.
Sifnugel et al. (Mon,) studied this question.
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