Cases of dementia have tripled in 20 years: “They are in the emergency room and they don’t even remember why they are there”

2023-10-20 04:00:00

Diagnoses of Alzheimer’s disease have tripled in Quebec over the past 20 years, creating a veritable tsunami of confused and sick seniors who bog down hospital emergency rooms.

“Definitely, these are the heaviest patients in the emergency room,” admits the D^rGilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec.

“When they come, it takes a lot of resources. Often, they are in the emergency room and they don’t even remember why they are there,” he gives as an example.

No less than 126,285 Quebecers were diagnosed with major neurocognitive disorders (especially Alzheimer’s) in 2019, according to a recent report from the National Institute of Public Health of Quebec (INSPQ). This is literally three times more than in 2000.

The famous gray tsunami

Without possible cure, this diagnosis leads to cognitive decline and prevents the person from taking care of themselves on a daily basis. Obviously, this increase in cases is directly linked to the aging of the population, the famous “gray tsunami” that the health network is not ready to face, according to many.

“Here we are. We are in the first wave and the others are coming, warns Sylvie Grenier, general director of the Quebec Federation of Alzheimer Societies. The care is not suitable […] and the hospital is surely the worst place for them. They become disorganized. We medicate them and it’s the beginning of the end.”

In 2019-2020, no less than 45% of people aged 65 and over with dementia went to a hospital emergency room at least once, compared to 25% of those without this diagnosis, according to the INSPQ.

Agitated and confused, these patients often arrive alone from home or by ambulance from a CHSLD. Whether it is a stomach ache, heart fibrillation or a fall, their treatment is complex.

“We can’t just leave them in the waiting room or a corridor, they are at risk of falling or running away. And they can’t eat alone, emphasizes the D^r Butcher. Sometimes we’re lucky because we have family there. But, she can’t stay 24 hours a day.”

Dr. Gilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec

Photo courtesy, ASMUQ

In addition, these patients are rarely priority cases, and spend long hours fasting and without medication (as a medical precaution). They therefore find themselves even more confused than before their arrival.

Three times more demented seniors (33%) were also hospitalized at least once in 2019-2020, compared to the rest of citizens aged 65 and over (13%), analyzed the INSPQ. Their hospital stay also lasts on average twice as long (29 days).

Difficulties with technology

According to several players in the field, the network must adapt more to seniors at home to prevent them from getting bogged down in emergencies.

“They come because they are not capable of managing technological means,” notes the D^r Boucher, in reference to Internet appointment booking systems.

According to a neurologist specializing in Alzheimer’s, establishing an early diagnosis also makes a difference.

“The costs of the health system will explode because these people have more pathologies in addition to cognitive disorders,” underlines the D^r Ziad Nasreddine. They take their medications less well and find themselves “off balance” with their diabetes or heart problems.”

Furthermore, five times as many people with dementia used antipsychotics and twice as many antidepressants in 2019.

“This use is concerning knowing that antipsychotics can be potentially inappropriate,” writes the INSPQ, citing side effects such as stroke, cognitive decline and death.