Emergency Care of Older Adults With Alzheimer Disease and Related Dementias

Although older adults (OAs) with Alzheimer disease (AD) and AD-related dementias who visit the emergency department (ED) have high short-term mortality, disposition to acute care, inpatient stays, and ED visits—as opposed to hospice—are still the preferred modes of care.

Researchers assessed ED disposition between OAs with AD and AD-related dementias compared with patients with non-dementia chronic disease while focusing on survival and health care utilization.

Data was extracted from Medicare claims from 34 hospitals identifying community-dwelling OAs aged 66 years or older with either AD/AD-related dementias or a non-AD/AD-related dementias chronic condition between January 1, 2014, and December 31, 2018.

Study authors compared ED disposition at the initial visit and health care utilization and mortality in the 12 months following an index ED visit while adjusting for gender, age, and risk of mortality.

The AD/AD-related dementias sample included 29,626 patients and the comparison sample included 317,046 patients. The patient sample include a higher percentage of older patients (82.4 years old [SD: 8.2] vs 76.0 years old [SD: 7.7]) as well as more female patients (59.9% vs. 54.7%) in the AD/AD-related dementia group.

Overall, the results demonstrated patients in the AD/AD-related dementia sample were more likely to experience the following:

• ED disposition to acute care (OR 1.039, P < 0.001, 95% CI 1.029–1.050);
• ED revisit (OR 1.077, P < 0.001, 95% CI 1.066–1.087); and an
• inpatient stay in the subsequent 12 months (OR 1.085, P < 0.001, 95% CI 1.075–1.095).

For both patient sample groups, ED disposition to hospice was low (0.2%).

Patients with AD/AD-related dementia demonstrated increased mortality risk (OR 1.099, P < 0.001, 95% CI 1.091–1.107) and higher short-term mortality (31.9% within 12 months) compared with the patient cohort of those without AD/AD-related dementias (15.3% within 12 months).

Reference:
Hill JD, Schmucker AM, Siman N, et al. Emergency and post-emergency care of older adults with Alzheimer disease/Alzheimer disease related dementias. J Am Geriatr Soc. Published online May 25, 2022. doi:10.1111/jgs.17833