A new study from the Regenstrief Institute and the Indiana University Center for Aging Research has revealed that older adults with dementia are more frequent visitors to emergency departments, returning at higher rates and incurring greater costs than older adults without dementia. The study findings shed light on the long-term patterns of healthcare use and mortality rates of elders with cognitive impairment who visit the emergency department.
For the study, researchers followed 32,697 individuals aged 65 and older with and without dementia who sought emergency care over an 11-year period at Eskenazi Health, a large, urban, safety-net healthcare system. The team observed that older adults with dementia are also more likely to be admitted to the hospital (not a trivial event for this age group) and have a higher death rate following an emergency department visit than those 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 visit than those without dementia. Five years after their first emergency department visit, only 46% patients with dementia were alive, while 76% patients without dementia had survived.’
Between one-third and half of elders with dementia made an emergency department visit in any given year. Five years after their first emergency department visit, only 46% of those with dementia were alive while 76% of older adults without dementia who visited an emergency department had survived.
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 said, "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. 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. Our findings, which were controlled for age, race, gender and health conditions in addition to degree of cognitive impairment, fill in gaps in knowledge about trajectories of care for older adults with dementia and provide an evidence-based starting point for future investigations that we should not defer."
Dr. LaMantia and colleagues said, "We were intrigued to find that 53% of patients with dementia visiting the emergency department were discharged rather than being admitted to the hospital, raising the issue of how medically necessary the emergency department visit was and whether these patients might have received care in a lower cost setting. 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."
Study co-author Frank Messina, M.D., associate professor of clinical emergency medicine and of clinical medicine at the IU School of Medicine, said, "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 especially for those, like patients with dementia, whose evaluations and management require more intensive, time-consuming, and multidisciplinary resources."