Steel, Peter A. D.; Hancock, David; Han, Jin H.; Madden, Eli; Stern, Michael; RoyChoudhury, Arindam; Wright, Adam; Ancker, Jessica S.; Zhang, Yiye; Rosen, Anthony. (2026). . BMC Geriatrics, 26(1), 991.
Deciding whether to admit or discharge older adults from the emergency department (ED) can be challenging because both options carry risks. This study examined return visit admissions, defined as hospitalizations within 72 hours after an older adult was initially treated and discharged from the same ED. Researchers analyzed nationally representative U.S. data from 2007 to 2022 for adults aged 65 and older. Of an estimated 3.38 million hospital admissions, 6.1% were return visit admissions. In-hospital death occurred in 4.0% of these admissions compared with 2.3% of admissions during the initial ED visit. After accounting for patient characteristics, illness severity, and other health conditions, return visit admissions were associated with higher odds of in-hospital death. No significant differences were found in hospital stay length or new nursing home placement. The most common diagnoses among return visit admissions were infections, including sepsis, pneumonia, COVID-19, cellulitis, and urinary tract infection. These findings suggest that hospital admission shortly after ED discharge may signal a higher risk of death in older adults, particularly those with infections, although the study does not show that delayed admission causes worse outcomes.
Fig 1 – Cohort Selection Flow Diagram for Older Adult Emergency Department Admissions, NHAMCS 2007鈥�2022