{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:10:33Z","timestamp":1774422633280,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/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"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33\/R61AG069822"],"award-info":[{"award-number":["R33\/R61AG069822"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R03AG078943"],"award-info":[{"award-number":["R03AG078943"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24AG054560"],"award-info":[{"award-number":["K24AG054560"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002076","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002076","id-type":"DOI","asserted-by":"publisher"}]}],"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>People with dementia are often hospitalized from the emergency department (ED) for conditions that could potentially be treated in the outpatient setting. In scenarios of clinical equipoise\u2014where either admission or discharge may be appropriate\u2014little is known about how emergency physicians make disposition decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study with attending emergency physicians at a single academic medical center. Interviews included open\u2010ended questions about disposition decision\u2010making in general as well as structured case scenarios using a think\u2010aloud protocol. We used an inductive approach to code interview data and elucidate themes about the factors emergency physicians consider in disposition decisions for people with dementia in\u00a0situations of clinical equipoise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We interviewed twenty\u2010one physicians with an average of 10.5\u2009years of clinical practice (range 5\u201321\u2009years). Five themes emerged: (1) assessing availability of, reliability of, and burden faced by caregivers; (2) anticipating clinical trajectory and feasibility of outpatient follow\u2010up; (3) identifying acute cognitive changes that may reflect serious underlying illness; (4) navigating medicolegal concerns; and (5) weighing potential harms of hospitalization. Among these, caregiver assessments and clinical trajectories were discussed most frequently, with physicians describing informal and variable approaches to caregiving assessments. While many physicians recognized the risk of discharging a delirious patient, few acknowledged that hospitalization itself could contribute to delirium or other harms. Overall, emergency physicians\u2019 decisions were shaped not only by patient characteristics, but by the surrounding health system's capacity to support timely and safe outpatient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ED disposition decisions for people with dementia often depend on caregiving context and health system constraints. Improving alignment of admission decisions with patients\u2019 and care partners\u2019 values and preferences may require structured approaches to assessing caregiver capacity and communicating risks of hospitalization. Health system investment in outpatient infrastructure and alternatives to admission may better support emergency physicians in making safe, patient\u2010centered decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70272","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:46:48Z","timestamp":1774356408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disposition at Equipoise: A Qualitative Study of Emergency Physicians' Decision\u2010Making About Hospitalizing People With Dementia"],"prefix":"10.1111","volume":"33","author":[{"given":"Anita N.","family":"Chary","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2800-8373","authenticated-orcid":false,"given":"Annika R.","family":"Bhananker","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Franks","sequence":"additional","affiliation":[{"name":"School of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Department of Medicine Baylor College of Medicine  Houston Texas USA"},{"name":"Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-7055","authenticated-orcid":false,"given":"Adrian D.","family":"Haimovich","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Martell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth M.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UMass Chan\u2014Baystate  Springfield Massachusetts USA"},{"name":"Department of Healthcare Delivery and Population Science UMass Chan\u2014Baystate  Springfield Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6249-1023","authenticated-orcid":false,"given":"Cameron J.","family":"Gettel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Yale University  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-3717","authenticated-orcid":false,"given":"Shan W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2723-4259","authenticated-orcid":false,"given":"Kei","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8755-7324","authenticated-orcid":false,"given":"Maura","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aanand","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Management, Policy, and Community Health, School of Public Health University of Texas Health Science Center  Houston Texas USA"},{"name":"Institute on Aging University of Texas Health Science Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish N.","family":"Shah","sequence":"additional","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Emergency Department Visits by Adults Age 65 and Older With Alzheimer Disease: United States, 2020\u20132022","author":"Loredana S.","year":"2024"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16636"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16231"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102019\u2010009587"},{"key":"e_1_2_13_6_1","volume-title":"The Business Case for Becoming an Age\u2010Friendly Health System","author":"Tabbush V. 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