The hospital emergency department can be a “chaotic” and toxic place for residents suffering from dementia. That’s why it’s all-the-more important for nursing homes to work closely with their hospital peers to make sure that they’re ready for such cases, a new analysis recommends.

The research, published in the latest Annals of Long-Term Care, notes that the emergency room can be overwhelming for anyone, but especially those with dementia. Often, its chaos leads to bouts of delirium for those with dementia, writes Freddi Segal-Gidan, Ph.D., an associate professor of clinical neurology and family medicine with USC’s Keck School of Medicine.

One positive response to this concern, she writes, is the development of a “geriatric ED designed and staffed to meet the unique needs of older adults.” That includes a quieter space where it’s easier to hear and see. The first geriatric ED opened in 2008, and it’s estimated there are now more than 100 nationwide.

For skilled-care operators, it’s important to “be aware of how older adults with dementia experience the ER, and to educate them on practical strategies, so that they are prepared to deal with, or hopefully avoid, a visit to the emergency department,” Segal-Gidan writes.

She also suggested expanding house calls to dementia patients, as an alternative to ED use, along with earlier initiation of palliative care. “These approaches might better serve patients with dementia, their families and the healthcare system,” the analysis concludes.