Emergency department revisits at thirty days are modestly explained by caregiver burden: a prospective cohort study

Importance: Caregivers play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue. Objective: We developed models describing how caregiver burden may predict ED revisits and admissions up to thirty days after discharge. Design: This prospective cohort study nested within the LEARNING WISDOM clinical trial included older adults and their caregivers who underwent a transition of care from one of four EDs in Quebec, Canada between January 1st, 2019, and December 21st, 2021. Setting: This study occurred within an integrated health multi-site organization consisting of four acute care hospitals. Participants: Patients aged 65 years or older who were discharged back to the community from the ED observation unit after being triaged to a stretcher on their index visit. Exposure: Caregiver burden, as collected using the brief twelve-item Quebec French version of the Zarit Brief Burden Interview (ZBI). Main Outcomes and Measure: Revisits to the ED were defined as a return to any ED in the 4-hospital network within 3, 7, or 30 days of the index visit. Admissions were return visits to the ED within 30 days resulting in hospitalization. Results: Among 1,409 caregiver-patient dyads, ZBI scores averaged 7.33 (SD = 7.11). Most caregivers were women (69%). Caregivers were most often spouses (48%) of patients or children of patients (38%). Among all patients, 5.3% returned to the ED within 3 days, 9.4% returned within 7 days, 20.7% returned within 30 days and 6.2% were admitted within 30 days. Each point increase on the ZBI scale was associated with a 2.8% increase in the odds of a 30-day revisit to the ED (p = 0.03), but not in models with shorter time windows, nor for admissions. ZBI scores on 30-day ED revisits were moderated by the COVID-19 pandemic waves: the first inter-wave period attenuated the association. Conclusions and Relevance: Caregiver burden may modestly predict ED revisits over 30 days. Future studies may enhance the management of ED revisits by predicting the longitudinal impact of caregiver burden on ED use in older adults. Trial Registration: https://clinicaltrials.gov/ct2/show/ NCT04093245