July 31, 2023 – People with Alzheimer's and other dementias are visiting emergency rooms at rates that suggest their caregivers are overwhelmed and lack higher options, based on researchers on the University of Michigan.
The emergency room visits often involve potentially unnecessary and frightening tests and the prescription of antipsychotics, which carry an increased risk of early death. The practice of using antipsychotics is typically known as “chemical coercion,” and the federal government is working to scale back the speed of antipsychotic prescriptions to older people through reporting requirements for care homes.
The Results were published this month within the magazine JAMA NeurologyThe researchers analyzed the information collected by the CDC national data on emergency department visits from 2016 to 2019 for people ages 65 and older. They found that there have been 1.4 million emergency department visits annually for individuals with dementia. (There are an estimated 6 million people living with dementia within the United States.)
The most typical reasons for emergency room visits for individuals with dementia were accidents (8%) and behavioral problems (7%). Behavioral problems include mood swings or day-night reversal, where an individual sleeps all day after which stays awake all night. People with dementia were twice as more likely to visit the emergency room for these two reasons as people aged 65 and over without dementia.
The researchers wrote that the high variety of visits to the doctor for behavioral problems “may be due to caregivers' difficulty in managing patients' behavior.”
People with dementia were significantly more more likely to have a urinalysis or a CT scan of the top as a part of the visit than older people without dementia, the study showed. Among individuals with dementia, 43% had a urinalysis, compared with 34% of individuals without dementia. 30% of individuals with dementia had a CT scan, compared with 17% of individuals without dementia. The authors noted that folks with dementia often cannot communicate well, which can explain additional testing.
“Our findings underscore the need for better methods to assess and manage [Alzheimer's Disease and Alzheimer's Disease Related Dementias] care in the outpatient setting to reduce potentially avoidable and harmful visits,” the authors concluded.
“While dementia is considered a cognitive disorder or memory impairment, it is the behavioral aspects of the disease, such as anxiety, agitation and sleep disturbances, that can cause the greatest stress for caregivers and patients,” said researcher Lauren B. Gerlach, DO, a geriatric psychiatrist on the University of Michigan Medical Center, in a opinion“Emergency departments are often not the right place to deal with these behaviors. We really need to better support caregivers so that there are options other than going to the emergency department.”