Post-discharge alcohol-related emergency department use among older adults following involuntary inpatient treatment for alcohol use disorder

Abstract

Objective The New South Wales Involuntary Drug and Alcohol Treatment (IDAT) program provides last-resort involuntary inpatient treatment for severe substance dependence. This study described older adults with severe alcohol use disorder (AUD) admitted to IDAT and their alcohol-related emergency department (ED) use after discharge. Methods This retrospective cohort study included patients aged ≥60 years with primary AUD admitted to an IDAT unit during 2016–2022. Demographic, social and clinical variables were summarised. Alcohol-related ED presentations before admission and after discharge were compared; time to first post-discharge presentation was examined using Kaplan–Meier analysis. Results Of 374 admissions, 37 older adults met inclusion criteria. Medical and psychiatric comorbidity, living alone and residence outside major cities were common. Among 36 participants included in post-discharge analyses, alcohol-related ED presentations were lower in the 6 months after discharge than in the 6 months before admission (median 1 vs 3, P < 0.001). Within 6 months, 22 participants (61%) re-presented, of whom 18 (82%) first re-presented within 3 months. Conclusions Older adults admitted to IDAT for severe AUD formed a clinically and socially complex cohort. Alcohol-related ED re-presentations were concentrated within 3 months of discharge, highlighting a high-risk transition period requiring structured continuity of care.