July 31, 2023 – People with Alzheimer’s disease and other dementias are visiting emergency departments at rates that suggest their caregivers are struggling and don’t have better options, according to researchers from the University of Michigan.
The emergency visits often include potentially unnecessary and frightening tests, as well as the prescription of antipsychotic drugs that carry an increased risk of early death. The practice of using antipsychotics is sometimes referred to as “chemical restraint,” and the government has been working to reduce the rate of antipsychotic prescriptions among older people through nursing home reporting requirements.
The findings were published this month in the journal JAMA Neurology. The researchers analyzed CDC-collected national data about emergency department visits from 2016 to 2019 for people ages 65 and older. They found that there were 1.4 million emergency visits annually among people with dementia. (There are an estimated 6 million people in the U.S. living with dementia.)
The most common reasons for emergency visits among people with dementia were accidents (8%) and behavioral disturbances (7%). Behavioral disturbances include mood fluctuations or what is called day-night reversal, which is when a person sleeps all day, then stays up all night. People with dementia were twice as likely to visit the ER for these two reasons, compared to people ages 65 and older who didn’t have dementia.
The researchers wrote that the high rate of visits for behavioral disturbances “may reflect caregiver difficulty in managing behaviors.”
People with dementia were significantly more likely to have a urinalysis or head CT scan conducted as part of their visit, compared to older people who didn’t have dementia, the study showed. Among people with dementia, 43% had a urinalysis, compared to 34% of people without dementia. For CT scans, 30% of people with dementia got the scan, compared to 17% of people without dementia. The authors noted that people with dementia often can’t communicate well, which could explain additional tests.
"Our findings highlight the need for better ways to evaluate and manage [Alzheimer's Disease and Alzheimer's Disease Related Dementias] care in outpatient settings to reduce potentially avoidable and harmful visits," the authors concluded.
"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," said researcher Lauren B. Gerlach, DO, a geriatric psychiatrist at the University of Michigan’s medical center, in a statement. “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.”