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A new study published in JAMA Neurology looked at the characteristics of emergency department visits among older adults with dementia.

“This study provides the first estimates of how often older adults with dementia utilize emergency services and the main reasons that drive such care,” study author Lauren Gerlach told us. “We anticipated that patients with dementia would utilize emergency services frequently but were unaware of what the main drivers of care were.”

As geriatric psychiatrist, Gerlach works clinically caring for patients with dementia and their care partners. She sees first-hand in her clinical work, just how challenging and distressing of an experience an emergency department visit can be for a patient living with dementia and their family.

“This is especially true in the context of a busy emergency department where visits can last many hours and patients may have difficulty understanding what is occurring or communicating their needs,” Gerlach told us. “Even routine blood draws from unfamiliar staff can be a very scary experience for a patient with dementia.”

The research team used a data source called the National Hospital Ambulatory Care Survey (NHAMCS) which collects data from a random sample of emergency department visits across the country from all payor types. From 2016 to 2019, they reviewed the annual number of emergency department visits among patients with dementia, the main reasons driving care, and the characteristics of the care received.

The biggest takeaways from this study were that each year there are 1.4 million emergency department visits among patients with dementia. This accounts for seven per cent of all emergency department visits among patients over the age of 65.

“The main reasons that drive emergency care are accidents and behavioral disturbances (e.g., symptoms such as agitation, anxiety, mood fluctuations),” Gerlach told us. “Once in the emergency department, compared to older adults without dementia, patients with dementia are more likely to have certain diagnostic testing completed including head CTs and urinalysis. Lastly, patients with dementia were also twice as likely to be exposed to sedative medications such as antipsychotics.”

Dementia is thought of as a memory disorder but it is often the behavioral aspects of the disease that can cause the most problems for patients and their families alike. Gerlach said it was interesting to see that these types of behaviors were one of the main drivers of emergency care.

“These results really highlight the need for enhanced caregiver support services to better help caregivers prevent and manage these distressing behaviors in the home setting,” Gerlach told us. “Emergency departments are often not the right place to manage these behaviors. Unfortunately, caregivers often don’t feel that they have ready access to resources or providers that they can turn to in managing these behaviors. We really need to do a better job to have these services available so that there are options other than seeking emergency care.”