Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and…

Cohort studyThe western journal of emergency medicine· May 2026

Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated Risks.

Victoria P Schulte, Cristina Guasch, Angela Landerholm, Danilo Rojas-Velasquez

Emergency Department FlowCohort studyQ1IF 2.2

Older adults awaiting psychiatric hospitalization boarded a median of 44 hours in the emergency departments

Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated Risks.

Victoria P Schulte … Danilo Rojas-Velasquez

The western journal of emergency medicine · May 2026 · Q1 in Emergency Medicine

Background

Older adults are increasingly presenting to emergency departments (emergency departments) with psychiatric emergencies amid limited inpatient psychiatric capacity, resulting in prolonged emergency departments boarding.

Methods

We measured boarding duration from initiation of a psychiatric bed search to emergency departments departure or psychiatric clearance.

n = 334 behavioral health encounters

44

Results

44

hours

over half boarded 24+ hours, longer stays tied to functional decline and restraint use

n = 334 behavioral health encounters

More results

Of 334 behavioral health encounters (mean age 76 years ± 7.4 years), 180/334 (53.9%) boarded ≥ 24 hours.

Functional decline occurred in 42/334 (12.6%) and restraint episodes in 27/334 (8.1%), with both events occurring only among encounters boarding ≥ 24 hours.

More results

Patients with neurocognitive disorders (157/334, 47.0%) had higher rates of functional decline (difference 17.1%, 95% CI, 7.3-26.4; P < .001) and restraint episodes (difference 11.2%, 3.0-19.1; P < .001) compared to patients without neurocognitive disorders.

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Conclusion · 1 of 2

In this community emergency departments cohort, older adults awaiting psychiatric hospitalization frequently experienced prolonged boarding, associated with higher rates of functional decline and physical restraint.

Conclusion · 2 of 2

Limitations include the retrospective design and reliance on nursing documentation to identify functional decline, with wide confidence intervals due to small event counts, limiting causal inference.

Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated Risks.

Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated Risks.

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