Despite a high likelihood of needing end-of-life care, patients with dementia who visit the emergency department typically transition to nonhospice settings and frequently return to the ED, according to a new study.
Investigators analyzed claims from more than 29,000 Medicare recipients with Alzheimer’s disease and related dementia, tracking discharge settings when compared to their peers without dementia. In the 12 months following an ED visit, those with dementia were more likely to be transferred to acute care, revisit the ED or experience an inpatient stay, reported Jacob D. Hill ND, MS, of New York University.
Patients with dementia also were twice as likely to die during those 12 months, at 32%, than their peers without dementia. Yet discharge to hospice was just as low for these patients as for the comparison group, at only 0.2% for each, Hill and colleagues found.
The findings are notable in part because patients with dementia are generally high users of hospice care, they authors wrote. Approximately 45% of those in hospice settings have either primary or comorbid dementia, they reported. Previous studies have found that about 72% of ED patients who receive post-acute care do so at a skilled nursing facility.
As the population of people with dementia grows, there will be a need for better-aligned ED treatment and discharge plans, the investigators contended. These plans should keep in mind the clinical status and preferences of people with dementia and their caregivers, the authors concluded.
The study was published in the Journal of the American Geriatrics Society.
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