Seniors with dementia frequent ED, incur high costs and poor outcomes: 4 findings

Among patient populations, seniors with dementia present a serious challenge for hospital emergency departments, according to new research from the Regenstrief Institute and the Indiana University Center for Aging Research in Indianapolis.

Researchers examined data on more than 32,600 individuals aged 65 and older with and without dementia who sought emergency care at Indianapolis-based Eskenazi Health — a large, urban, safety-net healthcare system — over an 11-year period.

They found:

1. Between one-third and half of the older adults with dementia made an ED visit in any given year, considerably more than those without dementia.

2. Those with dementia were more likely to be admitted to the hospital and have a higher mortality rate following an ED visit than those without dementia

3. Five years after their first ED visit, only 46 percent of those with dementia were alive, compared to 76 percent of older adults without dementia who visited an ED.

4. More than half (53 percent) of patients with dementia visiting the ED were discharged rather than being admitted to the hospital, raising the issue of how medically necessary the ED visit was and whether these patients might have been able to receive care in a lower cost setting.

"[EDs] 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 at the IU School of Medicine.



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