TOPLINE:

A prospective study showed that a higher caregiver burden was associated with more 30‑day emergency department (ED) revisits among community‑dwelling older adults, but it was not significantly associated with 3‑ or 7‑day revisits or 30-day revisits leading to hospitalization. The association between caregiver burden and 30-day ED revisits reversed during the first COVID-19 interwave period.

METHODOLOGY:

• Researchers conducted a prospective cohort study nested within LEARNING WISDOM, including 1409 dyads of community-dwelling patients aged 65 years or older (mean age, 77.06 years; 50.5% women) and their caregivers (mean age, 63.87 years; 69.6% women) across four EDs in an integrated health organization in Québec, Canada, between 2019 and 2021.
• Included patients were triaged to an observation unit stretcher during their index ED visit and were subsequently discharged to the community. Patients who were admitted to the hospital or transferred to another center were excluded.
• Caregiver burden was assessed using the Québec French version of the Zarit Burden Interview (ZBI) consisting of 12 questions (scores ranged from 0 to 48, with higher scores reflecting greater burden).
• Primary outcomes included ED revisits within 3, 7, or 30 days of the index visit and 30-day revisits resulting in hospitalization. Additionally, the moderating effects of COVID-19 pandemic waves were assessed.

TAKEAWAY:

• Among all patients, 20.7% returned to the ED within 30 days, 9.4% within 7 days, and 5.3% within 3 days, and 6.2% were admitted to the hospital within 30 days.
• Each 1-point increase on the ZBI scale was associated with increased odds of a 30-day ED revisit (odds ratio [OR], 1.03; P = .03); however, ZBI scores were not significantly associated with 3‑day (OR, 1.01; P = .69) or 7‑day (OR, 1.01; P = .55) revisits or with 30‑day revisits resulting in hospital admission (OR, 1.02; P = .24).
• A higher number of prior ED visits increased the odds of a 30‑day revisit (OR, 1.12; P = .03). For 30‑day revisits resulting in admission, walk‑in arrival (OR, 1.57; P = .046) and higher Charlson scores (OR, 1.17; P < .001) increased risk.
• The first COVID-19 pandemic interwave period appeared to reverse the association between ZBI scores and 30-day ED revisits (OR, 0.89; 95% CI, 0.79-0.99).

IN PRACTICE:

"In this cohort study of community-dwelling older adult patients and their caregivers, caregiver burden was associated with an increased likelihood of patient ED revisits within 30 days of the index visit, although not for shorter 3- and 7-day revisit intervals and not for revisits resulting in hospitalization," the authors wrote.

SOURCE:

The study was led by Nathalie Germain, MSc, Centre de recherche intégrée pour un systéme apprenant en santé et services sociaux, Lévis, Québec, Canada. It was published online on September 9, 2025, in JAMA Network Open.

LIMITATIONS:

The study was limited by potential selection bias. Telephone administration may have excluded patients with hearing impairment and, per ethics, excluded those with neurocognitive disorders, whose caregivers often have higher burden. Social desirability may have affected responses from both patients and caregivers. As the study was conducted during the COVID-19 pandemic, changes in care-seeking patterns and healthcare system pressures may also have affected the outcomes.

DISCLOSURES:

The study was funded by the Embedded Clinician Salary Award from the Canadian Institutes of Health Research, the Senior Clinical Scholar Award from the Fonds de Recherche du Québec-Santé, and a project grant from the Canadian Institutes of Health Research. Several authors reported having financial or other ties with various organizations. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.