Study: Older Dementia Patients Go to ER Twice as Often as Other Seniors

Washington Post | By Erin Blakemore
Older people with dementia seek care in the emergency room twice as often as their peers, a new analysis suggests — leading to what researchers call “potentially avoidable and harmful visits” for some patients.
The study, published July 24 in JAMA Neurology, examined data from the 2016-2019 National Hospital Ambulatory Medical Care Survey, which collects demographic and other information about a nationally representative sample of ER visits. About 1.4 million of the annual 20.4 million ER visits among adults over 65 involved patients with Alzheimer’s disease and related dementias, researchers found.
Patients with dementia presenting at the ER were more likely to be age 85 or older and female. The most common reasons for seeking care were accidents (7.9 percent), behavioral disturbances (7.4 percent) and general weakness (5.3 percent).
Once they got to the ER, patients with dementia were likelier to receive diagnostic tests such as CT scans and urinalysis — perhaps because of communication issues or behavioral concerns. They also were twice as likely to receive antipsychotic medication, which is cause for concern, the researchers write, because of the risks of taking such drugs and the potential for them to continue being used long-term. (Antipsychotics are associated with higher mortality risk and life-threatening falls in older adults.) They were less likely to be prescribed opioids than their counterparts.
The statistics reflect challenges in the daily lives of people with dementia, who may behave erratically and often cannot communicate about their symptoms. Despite these challenges, the study says the ER is often not the best place to care for adults with dementia due to long wait times, unfamiliar staff and a potentially disorienting environment.
The researchers call for better caregiver supports and the development of more geriatric-friendly emergency rooms, although they acknowledge that in some situations emergency care is needed.
“While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike,” study co-author Lauren B. Gerlach, a geriatric psychiatrist at Michigan Medicine and an assistant professor in psychiatry at the University of Michigan, said in a news release.
“Emergency departments are often not the right place to manage these behaviors,” she added. “We really need to do better to support caregivers so there are options other than seeking emergency care.”