Facility caregivers and their non-paid community counterparts who take care of Alzheimer’s and other dementia patients should receive more support to keep these individuals out of hospital emergency rooms.
That is a main conclusion from researchers who analyzed data from almost 1.4 million ER visits by this type of patient. They said their study fills a major knowledge gap that exists despite common knowledge that ER visits are common for Alzheimer’s and dementia patients. They account for approximately 7% of all emergency room visits for people 65 or older.
A University of Michigan team of investigators found that behavioral disturbances are the second most common reason for dementia patients needing to be transported to an emergency room.
As a result, behavioral changes and environmental factors affecting dementia patients in nursing homes should be scrutinized in an effort to reduce ER visits, said lead study author Lauren B. Gerlach, DO, an assistant professor in the Department of Psychiatry at the University of Michigan Medical School. She noted that the most common behavioral changes are sleep disturbances, anxiety and agitation.
“When we see behaviors like this in patients with dementia, we think of them as communication,” Gerlach told McKnight’s Long-Term Care News on Tuesday. “Many patients lose or have difficulty verbally communicating their symptoms so we have to investigate what’s driving those behaviors.”
Gerlach believes the study findings are powerful evidence for giving caregivers of the nation’s 6 million people with dementia more support. Reducing stress and risks of injury would have positive ripple effects throughout the healthcare system, she said.
ER: Wrong place at wrong time
“While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike,” she said in a release announcing study findings Monday. “Emergency departments are often not the right place to manage these behaviors. We really need to do better to support caregivers so there are options other than seeking emergency care.”
Even routine procedures, such as blood draws, can cause problems, she added. In addition, clinicians often lean on sedative medications to manage troublesome behaviors in this population — at more than twice the rate as other emergency patients over age 65 during their visit, the study shows. There is concern that newly started antipsychotic and sedative medications could then continue to be prescribed long-term, putting patients with dementia at further risk, Gerlach said.
Older adults with dementia also are more likely than those without to receive indiscriminate urine tests or CT scans of the head, researchers found.
Gerlach, who is also affiliated with the Institute for Healthcare Policy and Innovation at the University of Michigan, said that pain, urinary tract infections, changes in rooms or even a new roommate could disturb a dementia patient, causing them to have new or worse behaviors. She suggested that nursing home staff look for nonverbal signs of pain such as grimacing or whether newly prescribed medications could be at issue.
Staffing a root problem
However, Gerlach acknowledged that the national staffing crisis in nursing homes is making it harder for staff to devote adequate time to residents, especially those with Alzheimer’s or other forms of dementia.
“Nursing home staff are trying to do the very best they can with an extremely challenging situation right now,” she said, adding that facilities should provide consistency for patients with staff who know them and understand behaviors.
The study, “Characteristics of Emergency Department Visits Among Older Adults with Dementia,” analyzed data for emergency room visits from May 2, 2022, to January 17, 2023. Results were published Monday in JAMA Neurology.
Study data came from the National Hospital Ambulatory Medical Care Survey conducted by the Centers for Disease Control and Prevention, and include information on people over 65 no matter what form of health care coverage they had. The study was funded by the National institute on Aging, part of the National Institutes of Health.
