Dementia is often a slow moving health crisis, decades in the making. Yet it’s a diagnosis that drives more than 1.4 million trips to the emergency room every year.
Dementia in Emergency
In a JAMA Neurology research letter, University of Michigan trialists reported that people with Alzheimer’s disease and related dementias (ARDS) make up approximately 7 percent of all emergency department (ED) visits from people 65 and older. Put another way, the study found that 25.3 percent of ED visits by older adults were made by individuals with dementia-related conditions, while only 15.5 percent of the population in this age group had dementia.
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One of the reasons emergency visits were so common in ARDS patients, the study found, is that they tend to have multiple chronic health conditions. Nearly three quarters of older dementia patients who made a trip to the ED, had at least two additional documented medical issues. Only about 60 percent of older adults without dementia had other health complications that contributed to their emergency.
Dementia also made hospital admission more likely. Older adults with dementia were 1.34 times more likely to be admitted to the hospital after an ED visit than those without dementia, according to the study.
“Emergency departments are often not the right place to manage these behaviors,” Lauren B. Gerlach, the lead author of the study, said in a statement. “We really need to do better to support caregivers so there are options other than seeking emergency care.”
Potential Costs
As the authors highlighted, diagnostics and testing was common during ARDS-related emergency visits. Nearly 80 percent of those visits included at least one diagnostic test, such as a CT scan or MRI. They were also nearly twice as likely to receive central nervous system-active medication compared to older adults without dementia.
“Difficulty in the ability of patients with dementia to communicate their symptoms verbally can make it challenging to distinguish what is causing their symptoms,” Gerlach said.
Diagnostic extras tend to pile on the expenses. For example, according to a 2020 report by the Health Care Cost Institute, the average charge for an MRI in an emergency room setting was $2,611. The average charge for a CT scan in an emergency room setting was $1,111. However, cost of care can vary widely depending on a number of factors, including geographic location, insurance coverage, and out-of-pocket expenses. Patients with dementia were twice as likely to have Medicaid as their primary payer for ED visits, compared to those without dementia.
The authors called for an increase in geriatric-focused emergency departments to accommodate patients with dementia. Currently, these centers are currently few and far between in the US.
Utilizing data from the National Hospital Ambulatory Medical Care Survey, a Centers for Disease Control and Prevention (CDC) initiative, researchers analyzed over 30,000 ED visits by older adults with dementia. The study’s definition of dementia encompassed various types of cognitive impairment, including Alzheimer’s disease, vascular dementia, and other forms.
