ED Use in Dementia Peaks Before and After Dementia Diagnosis

Peaks in emergency department (ED) visits occur before and after a dementia diagnosis, which implies that the diagnostic process may provoke acute health care crises and heightened health care-seeking behavior among individuals with dementia and their caregivers, according to study results published in JAMA Network Open.

Researchers conducted a cohort study using data from the Medicare Current Beneficiary Survey between 2015 and 2021 to assess changes in ED use before and after an incident dementia diagnosis. Medicare beneficiaries aged 65 and older with an incident diagnosis of dementia were matched 1:2 to a population without incident dementia. The primary outcome was the rate of monthly ED visits for case patients in the 6 months before and after the date of diagnosis. A zero-inflated negative binomial regression model was used in statistical analyses.

A total of 1779 Medicare beneficiaries with incident dementia (mean age at diagnosis, 82.0; women, 59.6%; White, 82.8%) were matched to 3558 comparators without dementia (mean age at diagnosis, 81.9; women, 59.6%; White, 83.4%).

In the sixth month predating a dementia diagnosis, the ED visit rate was 1.69 per 100 beneficiaries vs 2.08 per 100 beneficiaries without a dementia diagnosis.

In the month immediately before and after a dementia diagnosis, the ED visit rate was 13.0 per 100 beneficiaries vs 2.95 per 100 beneficiaries without a dementia diagnosis and 3.32 per 100 beneficiaries vs 2.73 per 100 beneficiaries without a dementia diagnosis, respectively.

During the 12-month study period, a dementia diagnosis was associated with a 40% greater likelihood of having an ED visit (odds ratio [OR], 1.40; 95% CI, 1.25-1.58; P <.001).

The primary limitation of the study is the reduced generalizability of results to individuals who are not Medicare beneficiaries.

“Future longitudinal and qualitative studies are needed to elucidate the complex associations between dementia progression, comorbidities, and health care use,” the study authors concluded.