{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:14:28Z","timestamp":1774422868911,"version":"3.50.1"},"reference-count":61,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:00:00Z","timestamp":1774137600000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older adults are frequent users of the Emergency Department (ED), with a significant proportion presenting with pre\u2010existing or acute cognitive impairment. While negative post\u2010ED outcomes associated with cognitive status are well documented, their direct impact on care processes and resource allocation within the hospital remains poorly understood. This study aims to quantify how different cognitive profiles affect costs and care needs for acutely ill older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of a prospective cohort study at a single, tertiary care hospital. We included patients aged \u2265\u200965\u2009years admitted to the hospital through the ED. They were stratified into three groups based on the brief Confusion Assessment Method (bCAM) and the 10\u2010Point Cognitive Screener (10\u2010CS): normal cognition, cognitive impairment without delirium, and delirium. Primary outcome was cost of care. Resource utilization, characterized by the number of medical specialties involved, geriatric consultation, type of inpatient bed allocated from the ED, time to hospitalization, and patient satisfaction, were explored as secondary outcomes. Multiple regression models were used to assess associations, adjusting for sociodemographic factors, clinical severity, and geriatric vulnerability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample comprised 824 patients: 429 (52.1%) with normal cognition, 165 (20.0%) with delirium, and 230 (27.9%) with cognitive impairment without delirium. Clinical severity, but not cognitive status, was independently associated with costs (B\u2009=\u20090.18; 95% CI: 0.08, 0.27). Delirium was independently associated with allocation to high\u2010complexity bed and receiving a geriatric consultation. Cognitive impairment was independently associated with a greater number of specialties involved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinical severity showed the strongest association with costs. In contrast, cognitive profiles were independently associated with the care pathway and complexity, with delirium linked to higher\u2010acuity allocation and preexisting cognitive impairment without delirium to broader multidisciplinary involvement. Recognizing these distinct cognitive profiles is fundamental for anticipating care demands and optimizing resource allocation for this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70264","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T06:37:36Z","timestamp":1774247856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Triage: Cognitive Profiles and\n                    <scp>ED<\/scp>\n                    \u2010To\u2010Inpatient Costs and Resource Pathways in Older Adults"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9727-1012","authenticated-orcid":false,"given":"Julia","family":"Biegelmeyer","sequence":"first","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE), Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Geriatric Center for Advanced Medicine Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlon J. R.","family":"Aliberti","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE), Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Geriatric Center for Advanced Medicine Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"},{"name":"Research and Education Institute Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-0519","authenticated-orcid":false,"given":"Thiago J.","family":"Avelino\u2010Silva","sequence":"additional","affiliation":[{"name":"Geriatric Center for Advanced Medicine Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"},{"name":"Division of Geriatrics University of California San Francisco  San Francisco USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcia M. P.","family":"Serra","sequence":"additional","affiliation":[{"name":"Research and Education Institute Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian V.","family":"Morinaga","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE), Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Research and Education Institute Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-1635","authenticated-orcid":false,"given":"Pedro K.","family":"Curiati","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE), Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Geriatric Center for Advanced Medicine Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"},{"name":"Research and Education Institute Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,22]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"OPAS\/OMS \u201cD\u00e9cada do envelhecimento saud\u00e1vel nas Am\u00e9ricas (2021\u20132030) \u201d2023 accessed October 1 2025 https:\/\/www.paho.org\/pt\/decada\u2010do\u2010envelhecimento\u2010saudavel\u2010nas\u2010americas\u20102021\u20102030."},{"key":"e_1_2_12_3_1","unstructured":"United Nations DoEaSA Population Division \u201cWorld Population Prospects 2019 \u201daccessed October 1 2025 https:\/\/www.un.org\/development\/desa\/pd\/news\/world\u2010population\u2010prospects\u20102019\u20100."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.04.015"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.05.008"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2010.099226"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60054-8"},{"key":"e_1_2_12_8_1","unstructured":"(SIH\/SUS) MdS\u2010SdIHdS \u201cHospital Admissions by Year of Admission From 2022 to 2025 \u201daccessed in January 25 2026 http:\/\/tabnet.datasus.gov.br\/cgi\/tabcgi.exe?sih\/cnv\/niuf.def."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-020-00341-y"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","unstructured":"C.CairnsandK.Kang \u201cNational Hospital Ambulatory Medical Care Survey: 2022 Emergency Department Summary Tables \u201daccessed in October 1 2025 https:\/\/ftp.cdc.gov\/pub\/Health_Statistics\/NCHS\/Dataset_Documentation\/NHAMCS\/doc22\u2010ed\u2010508.pdf.","DOI":"10.15620\/cdc:121911"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.2006"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.2012"},{"issue":"2","key":"e_1_2_12_13_1","article-title":"Health Care Staffing Shortages and Potential National Hospital Bed Shortage","volume":"8","author":"Leuchter R. 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