Nav: Home

Regenstrief, IU study: Seniors with dementia make more emergency department visits

November 12, 2015

INDIANAPOLIS -- Older adults with dementia are more frequent visitors to emergency departments, returning at higher rates and incurring greater costs than older adults without dementia, according to a new study from the Regenstrief Institute and the Indiana University Center for Aging Research. The study is one of the first to explore long-term patterns of healthcare use and mortality rates of elders with cognitive impairment who visit the emergency department.

Older adults with dementia are also more likely to be admitted to the hospital (not a trivial event for this age group) and have a higher death rate following an emergency department visit than those without dementia, according to the study of 32,697 individuals aged 65 and older with and without dementia who sought emergency care over an 11-year period at Eskenazi Health, a large, urban, safety-net healthcare system.

Between one-third and half of older adults with dementia made an emergency department visit in any given year. Five years after their first emergency department visit, only 46 percent of those with dementia were alive while 76 percent of older adults without dementia who visited an emergency department had survived.

"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, M.D., M.P.H., 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.

"Our findings, which were controlled for age, race, gender and health conditions in addition to degree of cognitive impairment, fill in gaps in knowledge about trajectories of care for older adults with dementia and provide an evidence-based starting point for future investigations that we should not defer."

Dr. LaMantia and colleagues write that they were intrigued to find that 53 percent of patients with dementia visiting the emergency department were discharged rather than being admitted to the hospital, raising the issue of how medically necessary the emergency department visit was and whether these patients might have received care in a lower cost setting. Or, they posit, it is possible that decisions to discharge were flawed, due to missed medical complications, incomplete assessments of the safety of the patient's home environment or other factors.

"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, M.D., associate professor of clinical emergency medicine and of clinical medicine at the IU School of Medicine.
-end-
The study "Emergency Department Use Among Older Adults with Dementia" has been published online in advance of print publication in Alzheimer Disease & Associated Disorders. Authors, in addition to Dr. LaMantia and Dr. Messina, are Timothy E. Stump, M.A., and Douglas K. Miller, M.D., of the Regenstrief Institute and Christopher M. Callahan, M.D., of the IU Center for Aging Research, Regenstrief Institute and IU School of Medicine.

This work was supported by National Institute on Aging grants (5P30AG024967, 1K23AG043498 and 5K24AG024078).

Indiana University

Related Dementia Articles:

Flies the key to studying the causes of dementia
A research team from the University of Plymouth, University of Southampton and the Alexander Fleming Biomedical Sciences Research Center, Vari, Greece, have studied two structurally-similar proteins in the adult brain and have found that they play distinct roles in the development of dementia.
Stroke prevention may also reduce dementia
Ontario's stroke prevention strategy appears to have had an unexpected, beneficial side effect: a reduction also in the incidence of dementia among older seniors.
Dementia: The right to rehabilitation
Rehabilitation is important for people with dementia as it is for people with physical disabilities, according to a leading dementia expert.
One in 4 elderly Australian women have dementia
At least a quarter of Australian women over 70 will develop dementia according to University of Queensland researchers.
Rural dementia -- we need to talk
Research carried out by Plymouth University into the experience of dementia in farming and farming families, and its impact on their businesses and home lives, has identified four areas of concern which need to be addressed if dementia in the countryside is to be managed.
Women with dementia receive less medical attention
Women with dementia have fewer visits to the GP, receive less health monitoring and take more potentially harmful medication than men with dementia, new UCL research reveals.
Dementia on the downslide, especially among people with more education
In a hopeful sign for the health of the nation's brains, the percentage of American seniors with dementia is dropping, a new study finds.
New study suggests rethink of dementia causes
University of Adelaide researchers have developed a new theory for the causes of dementia and other neurodegenerative diseases, involving an out-of-control immune system.
Bleeding stroke associated with onset of dementia
Bleeding within the brain, or intracerebral hemorrhage, was associated with a high risk of developing dementia post stroke, according to research presented at the American Stroke Association's International Stroke Conference 2016.
Dementia: New insights into causes of loss of orientation
The University of Exeter Medical School led two studies, each of which moves us a step closer to understanding the onset of dementia, and potentially to paving the way for future therapies.

Related Dementia Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Jumpstarting Creativity
Our greatest breakthroughs and triumphs have one thing in common: creativity. But how do you ignite it? And how do you rekindle it? This hour, TED speakers explore ideas on jumpstarting creativity. Guests include economist Tim Harford, producer Helen Marriage, artificial intelligence researcher Steve Engels, and behavioral scientist Marily Oppezzo.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".