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Emergency rooms can be a frightening place for people suffering from dementia, yet each year 1.4 million Americans with Alzheimer's or other dementias wind up in crowded, noisy ERs, a new study finds.
"While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike," said researcher Dr. Lauren Gerlach, a geriatric psychiatrist at the University of Michigan's medical center.
"Emergency departments are often not the right place to manage these behaviors. We really need to do better to support caregivers so there are options other than seeking emergency care," she added in a Michigan Health news release.
For someone with dementia, the emergency room can be disorienting. "This is especially true in the context of a busy ED where visits can last many hours and patients may have difficulty understanding what is occurring or communicating their needs," Gerlach said. "Even routine blood draws from unfamiliar staff can be a very scary experience for a patient with advanced dementia."
To make matters worse, behavioral symptoms in this group are often treated with potentially dangerous sedative drugs.
These patients received antipsychotic medications at more than twice the rate of other patients over 65, the researchers found. These drugs are used to sedate people with dementia and calm their behavioral symptoms, but they have major risks if used long-term. These include increased risk of falls and death. The concern is that once started on these drugs they will continue to be prescribed them, putting patients at risk, Gerlach noted.
Dementia patients may also be treated differently in the emergency room. For example, people with dementia were more likely to receive a urine test or a CT scan of their head than patients without dementia.
"Difficulty in the ability of patients with dementia to communicate their symptoms verbally can make it challenging to distinguish what is causing their symptoms," Gerlach said. "Is it related to a change in their environment, difficulty between the patient and their caregiver, or an underlying medical issue?"
For the study, published July 24 in the journal JAMA Neurology, Gerlach's team used data from the National Hospital Ambulatory Medical Care Survey, which was conducted by the U.S. Centers for Disease Control and Prevention.
Gerlach believes that caregivers should be educated about how best to care for people with dementia, including how to prevent behavioral problems.
Geriatric-focused emergency departments or areas within larger emergency departments may also help, she noted, but they are not available in all areas.
Also, families need to be realistic about when it's time to get emergency services for someone with dementia, she noted.
If physical aggression or falling gets to be too much for caregivers to handle, the safety of the patient and the caregiver must outweigh the desire to keep them at home, Gerlach said.
"But before that, there is a lot we can do in the outpatient setting to help prevent crisis and the need for emergency care," she added.
For more on dementia, head to the U.S. National Institute on Aging.
SOURCES: University of Michigan, news release, July 24, 2023
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