Emergency Department Hallways Are Associated With Incident Delirium and Severe Agitation in Older Adults Living With Dementia

ABSTRACT Background Geriatric patients awaiting medical admission frequently experience extended emergency department (ED) stays and receive care in ED hallways. While prolonged ED stays are associated with increased delirium and mortality, the effect of placement in hallways remains unknown. This study's objective was to assess whether prolonged ED hallway exposure is associated with incident delirium and severe agitation in older adults and older persons living with dementia (PLWD). Methods We conducted a multi‐site retrospective cohort database study between January 1, 2022 and December 31, 2023 of older adults (age 65+) without prevalent delirium admitted to a general medicine service with an ED stay > 8 h. Patients were dichotomized into two groups: > 8 or < 8 h of care in ED hallways. Our primary outcome was incident delirium and severe agitation (a composite outcome of ICD‐10 code for delirium, positive nursing screen, use of parenteral antipsychotics, and/or physical restraints) after admission request. Secondary outcomes included hospital length of stay, inpatient and 30‐day mortality, and 30‐day ED revisit and readmission. We employed mixed‐effect logistic regression models, independent of and mediated by history of dementia and adjusted for additional confounders. Results Our sample included 11,105 patients (median age 77, 51% female), with 2299 in the hallway group and 8806 in the non‐hallway group. Prolonged ED hallway exposure was not associated with delirium and severe agitation for our general geriatric cohort (OR 0.87 0.53–1.42) but was for PLWD (OR 1.48 1.03–2.13). We observed no association between hallway care and our secondary outcomes except that the hallway group was associated with lower 30‐day readmission (OR 0.69 0.52–0.92). Conclusions Prolonged ED hallway care was not associated with delirium and severe agitation in a general geriatric cohort but was for older PLWD. Prospective research is needed to determine if hospitals should consider prioritizing PLWD for rooms.