Study: Dementia becomes an emergency 1.4 million times a year

A new study by the University of Michigan has found that people with Alzheimer's disease and other forms of dementia end up in the emergency room 1.4 million times a year.

The study, published in JAMA Neurology, found that these patients are twice as likely as their peers who don't have dementia to seek emergency care after an accident or a behavioral or mental health crisis.

Lead author Lauren B. Gerlach, D.O., M.Sc., says the findings could help inform efforts to support family caregivers and nursing facility staff in reducing patients' risks of injury, and preventing the agitation, aggression and distressing behaviors that people with dementia can experience.

"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," said Gerlach, a geriatric psychiatrist at Michigan Medicine, U-M's academic medical center. "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."

The study also found that people with dementia were much more likely than those without to receive a urine test or a CT scan of their head. This is likely because it can be difficult to distinguish what is causing the patient's symptoms when they cannot communicate their symptoms verbally.

Gerlach and Matthew A. Davis, Ph.D., an associate professor in the U-M School of Nursing and Michigan Medicine's Department of Learning Health Sciences, note that there has not been much research on emergency care for people with dementia, despite the fact that clinicians and caregivers who care for such patients know from experience that emergencies can be common.

They say that caregiver stress and burnout from a lack of respite or support may play a role in the need for seeking emergency care in people with dementia.

Gerlach sees promise in a new proposed Medicare rule that would allow health care teams to get reimbursed for sessions that educate family caregivers—including on how to prevent or soothe behavioral symptoms among their loved ones.

She also recommends the caregiver support programs and information offered by the Alzheimer's Association, and videos from UCLA Health, available in multiple languages, to her patients' caregivers to help manage these behaviors.

Those who live with people who have dementia should also consider safety upgrades in the home to reduce fall risks and the chance of other injuries.

"It's important to match the home environment to their needs and ability, which could reduce the risk of emergency care being needed," Gerlach said.

The rise of geriatric-focused emergency departments or areas within larger emergency departments may also help, Gerlach noted, but they are not available in all areas.

It's also important for families to be realistic about when it's time to seek emergency services for their loved one with dementia.

If physical aggression or falling risk gets to be too much for a family caregiver to handle, the safety of the patient and the caregiver must outweigh the desire to keep them at home, Gerlach says. "But before that, there is a lot we can do in the outpatient setting to help prevent crisis and the need for emergency care," she said.

Journal Information: Lauren B. Gerlach et al, Characteristics of Emergency Department Visits Among Older Adults With Dementia, JAMA Neurology (2023). DOI: 10.1001/jamaneurol.2023.2244. jamanetwork.com/journals/jaman … /fullarticle/2807210