Dementia Patients Make More Use of EDs with Worse Outcomes

Seniors with dementia use the emergency department more often than those without cognitive impairment, garnering higher costs but worse outcomes, a new study suggests.

Researchers from Regenstrief Institute and the Indiana University Center for Aging Research in Indianapolis, IN, looked at patterns of health care use among patients ages 65 and older in a large, urban, safety-net health system called Eskenazi Health. Combining Medicare and Medicaid claims data with other data sets from the system, the examined 175,652 visits to EDs by 10,354 adults with dementia and 15,020 without it over 11 years. The cohort was controlled for age, race, gender, and health conditions, as well as degree of cognitive impairment.

They found that between one-third and half of older adults with dementia in the system made a visit to the ED in any given year, but their outcomes were significantly worse than those without cognitive impairment. Five years after the first visit logged, only 46% of dementia patients were still alive, compared with 76% of those without dementia. Overall, patients with dementia made more frequent visits to the ED, returned more often, and incurred high costs. The study was published online in the October 29 issue of Alzheimer Disease & Associated Disorders.

The authors noted, however, that 53% of patients with dementia were not admitted to the hospital after their emergency visit. This raises the question, they suggested, of whether the visits were medically necessary or if the patients would be better served in a lower-costs setting such as a physician’s office or clinic, or whether the hospital could have missed complications, home safety concerns, or other problems that were ground to admit the patient.

"Emergency departments are appropriately focused on recognizing and stabilizing acute life-threatening conditions and should not be, but are often used as, a substitute for ongoing comprehensive primary care especially for those, like patients with dementia, whose evaluations and management require more intensive, time-consuming, and multidisciplinary resources," said study co-author Frank Messina, MD, associate professor of clinical emergency medicine and of clinical medicine at the IU School of Medicine, in a news release.

"As people live longer we will increasingly be faced with a growing number of individuals with cognitive impairment. We now know that survival rates after an ED visit differ significantly by cognitive status," said IU Center for Aging Research and Regenstrief Institute investigator Michael LaMantia, MD., MPH, assistant professor of medicine at IU School of Medicine. "We need to continue to learn how to provide better care to these vulnerable individuals in fast-paced emergency departments and after their visits to the ED.”