A new study has found that older adults with dementia make more frequent visits to emergency departments, returning at higher rates, and incurring greater costs than older adults without dementia.
Older adults with dementia are also more likely to be admitted to the hospital and have a higher death rate following an emergency department (ED) visit than those without dementia, according to researchers at the Regenstrief Institute and the Indiana University (IU) Center for Aging Research.
The new study included 32,697 people 65 and older, with and without dementia, who sought emergency care over an 11-year period at Eskenazi Health, a health care system in Indianapolis, Indiana.
The study found that between one-third and one-half of older adults with dementia made an emergency department visit in any given year. Five years after their first ED visit, only 46 percent of those with dementia were alive, compared with 76 percent of older adults without dementia.
“As people live longer, we will increasingly be faced with a growing number of individuals with cognitive impairment. We now know that survival rates after an ED visit differ significantly by cognitive status,” said IU Center for Aging Research and Regenstrief Institute investigator Michael LaMantia, M.D., M.P.H., assistant professor of medicine at IU School of Medicine.
“We need to continue to learn how to provide better care to these vulnerable individuals in fast-paced emergency departments and after their visits to the ED.”
The findings were controlled for age, race, gender, and health conditions, in addition to degree of cognitive impairment, he said.
The researchers noted in their study that they were “intrigued” to find that 53 percent of patients with dementia visiting the emergency department were discharged rather than being admitted to the hospital. This raises the issue of how medically necessary the emergency department visit was and whether these patients might have received care in a lower cost setting, the researchers speculate.
Or, they posit, it is possible that decisions to discharge were flawed, due to missed medical complications, incomplete assessments of the safety of the patient’s home environment or other factors.
“Emergency departments are appropriately focused on recognizing and stabilizing acute life-threatening conditions and should not be, but are often used as, a substitute for ongoing comprehensive primary care” said study co-author Frank Messina, M.D., an associate professor of clinical emergency medicine and of clinical medicine at the IU School of Medicine.
That is especially true, he said, “for those, like patients with dementia, whose evaluations and management require more intensive, time-consuming, and multidisciplinary resources.”
Source: Indiana University