Reasons for repeated emergency department visits among community‐dwelling older adults with dementia in Ontario, Canada

Abstract

Background: Community-dwelling older adults living with dementia visit the emergency department (ED) more frequently than other older adults, but research on the reasons for repeated visits is lacking. We examined the rate of repeated ED visits and reasons for visits in a cohort of individuals with dementia. Methods: We conducted a population-based retrospective cohort study of community-dwelling older adults (≥66 years) living with dementia in Ontario, Canada, who visited the ED and were discharged home between April 1, 2010, and March 31, 2019. We calculated the proportion of the population with one, two, and three or more repeat ED visits within 1 year of the baseline visit and the categorized the reason for the visits.Results: Our cohort contained 175,863 individuals with dementia who visited the ED at least once. Overall, 66.1% returned at least once to the ED within 1 year, 39.4% returned twice, and 23.5% returned 3 or more times.Visit reasons were heterogenous and were most frequently related to general signs and symptoms (25.3%) while being infrequently due to cognitive or behavioral reasons (5.9%). Individuals typically visited for different reasons across successive visits. Conclusions: Community-dwelling older adults with dementia who visited an ED were very likely to return to the ED within a year, with a substantial

Aren't you forgetting something? Cognitive screening beyond delirium in the emergency department

“…Without a standard strategy for cognitive screening in the ED, cognitive impairment in the absence of delirium would remain highly undetected, 3,5 as most patients identified as cognitively impaired in the 10‐CS did not have a previous dementia diagnosis or substantial cognitive complaints. Like delirium, cognitive impairment without delirium was associated with increased in‐hospital adverse events, prolonged LoS, and in‐hospital mortality, capturing risks beyond routine ED measures 1–3 . Although barriers exist (e.g., resource‐constrained settings and stressors related to acute illnesses), 9,10 our findings encourage broader cognitive screening for older patients in the ED.…”

“…Patients with cognitive impairment, particularly those living with dementia, are more likely to be admitted to the hospital and die after an emergency department (ED) visit 1,2 . Nonetheless, cognitive assessments at the ED are scarce and primarily focused on delirium 3,4 .…”

“…Patients with cognitive impairment, particularly those living with dementia, are more likely to be admitted to the hospital and die after an emergency department (ED) visit. 1,2 Nonetheless, cognitive assessments at the ED are scarce and primarily focused on delirium. 3,4 Although delirium is a central aspect of acute geriatric care, patients with pre-existing cognitive impairment without delirium are at high risk of going undetected.…”

Examining the immediate and ongoing impact of the COVID-19 pandemic on population-based estimates of dementia: a population-based time series analysis in Ontario, Canada

“…The increase in the ascertainments in hospital is concordant with published reports that hospital admission rates for dementia and delirium increased or held study during the pandemic even as overall hospitalisation rates declined. 2 31–33 The population with 11 or more health conditions is small, representing approximately 7% of the older adult population without dementia, but is highly comorbid, is at high risk of developing dementia and frequently uses the healthcare system. 34 The higher incidence in this population may be partially a result of increased social isolation in those living alone and visitation restrictions in hospitals and congregate care settings.…”

Development and Validation of a Nomogram for Predicting Risk of Emergency Department Revisits in Chinese Older Patients

“… 23 Other studies reported even higher rates possibly owing to their different focuses on populations with older age or affected by particular diseases, for instance, the rate was recorded as 60% among patients over 75 years 8 or was two-thirds (66.1%) among community-dwelling older adults living with dementia. 24 The exact reasons for high ED-return rates in older patients are uncertain, but may depend on potential factors such as poor quality of care or medical errors at the initial ED visit, patient’s chronic medical conditions with high relapse possibilities, and inadequate primary care or continuity of care.…”