INTRODUCTION: After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS: We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner-completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi-structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS: Care partners mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: 1) unique care considerations while in the ED setting impact the perceived success of the care transition, 2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, 3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and 4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION: Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner-reported outcome measures as well as ED discharge care transition interventions targeting care partners.

The authors have declared no competing interest.

Dr. Gettel is a Pepper Scholar with support from the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342), the National Institute on Aging (NIA) of the National Institutes of Health (R03AG073988), the Alzheimers Association (ARCOM-22-878456), and the NIA Imbedded Pragmatic Alzheimers and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory; U54AG063546). Dr. Venkatesh is supported by the American Board of Emergency Medicine National Academy of Medicine Anniversary fellowship and previously by the Yale Center for Clinical Investigation (KL2TR000140) from the National Center for Advancing Translational Science. Dr. Cohen is supported by the NIA (K76AG059987). Dr. Monin is supported by the NIA (U54AG063546, R01AG058565). Dr. Feder received funding from the National Heart Lung and Blood Institute (K12HL138037) of the NIH and the Yale Center for Implementation Science. Dr. Hwang is supported by the NIA (R33AG058926, R61AG069822), by the John A Hartford Foundation, and the West Health Institute. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.

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The IRB of Yale University gave ethical approval for this work.

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