senior man with depression in wheel chair
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A significant portion of community-dwelling older adults with dementia display a pattern of repeated emergency department (ED) visits, according to a new study published in the Journal of the American Geriatrics Society. Patients with a history of frequent visits may be in need of increased clinical supports, the authors said.

“Recurrent ED visits may be a result of unmet healthcare needs and indicate that there are opportunities to improve care,” lead researcher Aaron Jones, PhD, of McMaster University in Canada, wrote. “Additionally, repeated visits increase the risk of older adults experiencing adverse events in the ED.”

The study analyzed ED visits among community-dwelling adults aged 66 years and older living in Ontario, Canada, over nearly 10 years. Among more than 175,000 participants, the groups at highest risk of recurrent ED visits included patients who were more frequently prescribed anticonvulsants, antipsychotics and benzodiazepines, and those who resided in rural and low-income areas.

Strongest risk predictor

An ED visit or visits during the prior year was the strongest predictor of recurrent visits and perhaps the most useful for identifying older adults in need of interventions, the investigators reported.

“In our study, the risk associated with even a single visit in the previous year was higher than the next strongest risk factor of being 95 years or older,” Jones and colleagues wrote. “Past ED use would be a useful measure to identify patients who would benefit from closer follow-up, geriatric referral, ED-to-community transition support and closer engagement with primary care and home care.”

To further improve these patients’ care experiences, shared decision-making, collaborative medication review, and closer follow-up and engagement with community supports may be necessary, they added.

The authors advocated for dementia-friendly and geriatric-focused EDs as well. “While implementing some ED interventions may be infeasible given the current ED staffing and funding challenges, knowledge translation and educational interventions could yield benefits with limited on-going costs,” they concluded.

Dementia prevalence is expected to increase globally, from 57 million patients in 2020 to 153 million by 2050. At the same time, higher healthcare costs and barriers to diagnosis and care access are creating disparities, the authors noted. 

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This article originally appeared on McKnights Home Care