Caregiver Depression Associated with Increase in Emergency Department Visits

A recent study has found that dementia patients who had a caregiver with a diagnosis of depression experienced a 73% increase in the rates of emergency department use compared to other dementia patients.

After examining emergency departments use among dementia patients, investigators found that those whose caregiver suffered from depression visited 1.5 times per year compared to 0.8 visits per year, which was the prevalence among patients whose caregivers were not impacted by depression. 



In order to determine whether caregiver depression is associated with emergency department use, investigators identified data from 780 patient-caregiver dyads that were screened between March 2015 and Feb. 2017 as part of the Care Ecosystem trial.

After screening and applying inclusion criteria, a total of 663 caregiver-patient dyads were included in the study. Information obtained from these dyads came from baseline and 6-month follow-up surveys from the Care Ecosystem trial. Emergency department visits were defined as any emergency department evaluation — regardless of institution or disposition.

The patients with dementia had a mean age of 77.3 years and 55.4% of them were female. Caregivers had a mean age of 64.9 years, 70.4% were men, and 94.3% were either a spouse, domestic partner, or first-degree relative of the patient. 


Of the 663 dyads involved, a cohort of 84 (12.7%) caregivers had depression at baseline. Investigators found that the mean incidence rate of emergency department visits was 0.9 per person-year and that rates of emergency department was higher among dyads whose caregiver had depression versus those who did not (1.5 versus .08).

After analyses adjusting for age, sex, severity of dementia, baseline emergency department use, and caregiver age and sex, investigators found that caregiver depression continued to be associated with emergency department visits — investigators noted a 73% increase in rates of emergency department use among dyads with caregivers with depression (1.73; 95% CI, 1.30-2.30). Additionally, investigators found that caregiver depression was associated with higher emergency department use in an unadjusted model, but this association reach statistical significance after adjustments (1.19; 95% CI, 0.93-1.52). Caregiver self-efficacy was inversely proportional to the number of emergency department visits in the adjusted and unadjusted models.

Investigators noted multiple limitations within their study. Due to dyads being invited to participate, dyads with higher depression and levels of burden likely declined enrollment. Assignment to the original trial’s intervention group could have impacted emergency department visits — authors noted a model adjusting for this covariate did not change results. Additional potential sources for residual confounding continue to be present. Lastly, the study only included patients from 3 states.

This study, titled “Association Between Caregiver Depression and Emergency Department Use Among Patients With Dementia,” is published in JAMA Neurology.