ED Visits Before and After Dementia Diagnosis

TOPLINE:

Having a diagnosis of dementia is associated with an increase in emergency department (ED) visits in the United States, highlighting a potential health crisis and the need for screening for early cognitive impairment.

METHODOLOGY:

• The study analyzed data from the Medicare Current Beneficiary Survey (2015-2021) and included 1779 patients who were newly diagnosed with dementia (mean age at the time of diagnosis, 82 years; 60% women; 83% White and 17% belonging to racial or ethnic minorities).
• Participants with incident dementia were 1:2 propensity score–matched to 3558 control individuals without dementia on the basis of age, sex, race and ethnicity, and number of chronic conditions.
• The primary outcome was the number of monthly ED visits for participants with and without dementia in the 6 months before and after the date that case patients were diagnosed with dementia.

TAKEAWAY:

• In the sixth month before the diagnosis of dementia, patients with dementia made fewer visits to the ED than those without dementia (1.69% vs 2.08%).
• In the month immediately before the diagnosis of dementia, patients with dementia made more ED visits than those without dementia (13% vs 2.95%).
• In the month immediately after the diagnosis of dementia, patients with dementia had a higher likelihood of visiting the ED than those without dementia (3.32% vs 2.73%), with a 40% increase in the likelihood of visiting the ED observed over the entire 12-month period (P <.001>

IN PRACTICE:

“ED visits may trigger a diagnostic cascade toward dementia, reflecting the complex nature of dementia identification and management. Often a crucial contact point, the ED setting provides a valuable opportunity to screen for cognitive impairment, which might otherwise go unnoticed until it has progressed substantially,” the authors wrote.

SOURCE:

The study was led by Cameron J. Gettel, MD, MHS, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, and was published online on October 14, 2024, in JAMA Network Open.

LIMITATIONS:

The study findings were specific to Medicare beneficiaries and may not apply to other populations. Additionally, the study may not have captured milder forms of cognitive impairment.

DISCLOSURES:

The study was supported by grants from the National Institute on Aging (NIA), NIA IMPACT Collaboratory, and Alzheimer’s Association and an award from the National Academy of Medicine. Three authors reported receiving funding from various sources during or outside this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.