TOPLINE:
The presence of a dementia diagnosis significantly correlates with an increase in emergency department (ED) visits across the United States, underscoring a burgeoning health crisis and emphasizing the urgent need for proactive screening methods to detect early cognitive impairment.
METHODOLOGY:
- Researchers conducted a comprehensive analysis utilizing data from the Medicare Current Beneficiary Survey collected between 2015 and 2021, focusing on a cohort of 1779 patients who were newly diagnosed with dementia; the average age at diagnosis was 82 years, with women constituting 60% of the participants, while 83% identified as White and 17% represented various racial or ethnic minorities.
- The study employed a robust methodology wherein participants diagnosed with dementia were propensity score-matched at a ratio of 1:2 with 3558 control subjects devoid of dementia, ensuring comparable demographics regarding age, sex, race, ethnicity, and the presence of chronic health conditions.
- The primary outcome measure assessed was the frequency of monthly ED visits for both participants diagnosed with dementia and those without throughout the six months proceeding and following their dementia diagnosis.
TAKEAWAY:
- During the six months leading up to the diagnosis, individuals with dementia exhibited lower rates of ED visits compared to their counterparts, with figures at 1.69% versus 2.08%, respectively.
- Unsurprisingly, in the month prior to receiving their dementia diagnosis, patients revealed an alarming spike in ED visits, tallying 13% compared to a mere 2.95% for those without dementia.
- Remarkably, the month following the diagnosis saw a further escalation, as patients diagnosed with dementia demonstrated a 3.32% likelihood of visiting the ED, surpassing the 2.73% for those not diagnosed, culminating in a staggering 40% overall increase in ED visits observed throughout the ensuing 12-month period (P < .001).
IN PRACTICE:
“ED visits may trigger a diagnostic cascade toward dementia, highlighting the intricate challenges associated with identifying and managing the condition. The emergency department serves as a pivotal contact point, presenting a crucial opportunity for screening cognitive impairment, which might otherwise remain undetected until it has progressed considerably,” the authors elaborated.
SOURCE:
The groundbreaking study was directed by Cameron J. Gettel, MD, MHS, from the Department of Emergency Medicine at Yale School of Medicine, located in New Haven, Connecticut, and the findings were published online on October 14, 2024, in the esteemed journal JAMA Network Open.
LIMITATIONS:
The insights derived from this study specifically pertain to Medicare beneficiaries and may not be entirely applicable to diverse populations. Furthermore, the research may not adequately encompass milder manifestations of cognitive impairment, potentially limiting the scope of its findings.
DISCLOSURES:
This research received vital support from grants funded by the National Institute on Aging (NIA), the NIA IMPACT Collaboratory, and the Alzheimer’s Association, along with an award from the National Academy of Medicine. Three authors disclosed receiving financial backing from various institutions throughout the duration of the study or in related activities.
Dementia: A Trip to the ED and Back
TOPLINE:
Welcome, folks! Today we’re diving into a study that’s more enlightening than an episode of Friends when it first aired! It turns out that having a diagnosis of dementia is sending more people to the emergency department (ED) like it’s the hottest club on a Saturday night. Yes, there’s a rising tide of ED visits in the United States linked to dementia, and it’s raising some eyebrows—cue panic music! Let’s unpack this potential health crisis and chat about why screening for early cognitive impairment is more essential than holding onto the shopping cart in a supermarket on a Saturday afternoon.
METHODOLOGY:
- The study rummaged through data from the Medicare Current Beneficiary Survey (2015-2021), involving 1,779 newly diagnosed patients with dementia. The average age at diagnosis? A sprightly 82 years old! And don’t even get me started on the demographics—60% women, 83% White, and 17% racial or ethnic minorities. You’d think they were trying to cast a “Granny and Me” sitcom!
- In a charming twist of fate, each person diagnosed with dementia was matched with two controls (3558 of them, to be precise) without dementia. They were paired based on age, sex, race, ethnicity, and the number of chronic conditions—because who doesn’t love a good matchmaking story?
- Now, what did they measure? ED visits—because when in doubt, always follow the patients. They compared visits in the six months before and after the diagnosis of dementia to see just how popular the ED became.
TAKEAWAY:
- Hold onto your hats! In the month just before the diagnosis of dementia, our patients seemed to be enjoying their peace, making fewer ED trips than those without dementia—1.69% vs. 2.08%. Apparently, ignorance is bliss!
- But wait! Just like that plot twist you didn’t see coming, in the month prior to that diagnosis, dementia patients decided to fuel their emergency department visits to a whopping 13% compared to a mere 2.95% of the control group. Talk about a spike that could rival a roller coaster at the county fair!
- After the diagnosis? Bam! Dementia patients practically turned the ED into their second home, with a higher likelihood of visits—3.32% vs. 2.73%. Over a full year, there was an eye-popping 40% increase in the likelihood of these visits! Can someone book them a frequent flyer card already?
IN PRACTICE:
The authors really hit the nail on the head when they mentioned that “ED visits may trigger a diagnostic cascade toward dementia.” This could mean that the ED, being this chaotic hub of excitement (and sometimes, absolute lunacy), is a golden opportunity for screening cognitive impairment that might be hiding in plain sight until it’s too late. It’s like finding a tenner in your pocket—you didn’t expect it, but you’re glad it’s there!
SOURCE:
This fascinating study, led by Cameron J. Gettel, MD, MHS, from the Yale School of Medicine, was published in JAMA Network Open on October 14, 2024. And yes, they were not horsing around with the data!
LIMITATIONS:
Now, let’s not get too carried away on the exuberance train. As fabulous as this research is, it’s limited to Medicare beneficiaries—so, it might not ring true for everyone out there. Plus, they could’ve missed mild cognitive impairments, much like my dad misses the point in a conversation when he’s talking about golf.
DISCLOSURES:
Lastly, let’s sprinkle a bit of transparency over the findings; they were backed by grants from the National Institute on Aging and the Alzheimer’s Association, among others. So yes, they had some support, which is lovely—just like when your mate picks up the tab at dinner.
In summary, this study gives us valuable insights into the burgeoning connection between dementia diagnoses and emergency department visits. We’ve got plenty to ponder when it comes to early screening. So the next time you find yourself in an ED and you see someone wandering in looking hopelessly confused, just remember, it may not only be lost keys they are seeking!
