Emergency Department Use by Community-Dwelling Individuals With Dementia in the United States: An Integrative Review

Lauren J Hunt, Lorinda A Coombs, Caroline E Stephens, Lauren J Hunt, Lorinda A Coombs, Caroline E Stephens

Abstract

As part of the National Plan to Address Alzheimer's Disease, reducing potentially avoidable emergency department (ED) use by individuals with dementia has been identified as a component of enhancing the quality and efficiency of care for this population. To help inform the development of interventions to achieve this goal, an integrative review was conducted to: (a) compare rates and reasons for ED visits by community-dwelling individuals with and without dementia, considering also the effect of dementia subtype and severity; and (b) identify other risk factors for increased ED use among community-dwelling individuals with dementia. Nineteen articles met inclusion criteria. Individuals with dementia had higher rates of ED visits compared to those without dementia, although differences were attenuated in the last year of life. Increased symptoms and disability were associated with increased rates of ED visits, whereas resources that enabled effective management of increased need decreased rates. Gerontological nurses across settings are on the frontlines of preventing potentially avoidable ED visits by community-dwelling individuals with dementia through patient and family education and leadership in the development of new models of care. [Journal of Gerontological Nursing, 44(3), 23-30.].

Conflict of interest statement

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Copyright 2018, SLACK Incorporated.

Figures

Figure 1
Figure 1
The Andersen Behavioral Model of Health Care Use adapted to emergency department (ED) use by community-dwelling individuals with dementia.
Figure 2
Figure 2
Article selection flow diagram. Note. ED = emergency department.

References

    1. Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Annals of Emergency Medicine. 2002;39:238–247.
    1. Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JP. Continuity of care and health care utilization in older adults with dementia in fee-for-service Medicare. JAMA Internal Medicine. 2016;176:1371–1378. doi: 10.1001/jamainternmed.2016.3553.
    1. Andersen RM. Behavioral model of families’ use of health service. Chicago, IL: University of Chicago Center for Health Administration Studies; 1968.
    1. Andersen RM, Davidson PL. Improving access to care in America: Individual and contextual indicators. In: Andersen RM, Thomas TH, Kominski GF, editors. Changing the U.S. health care system: Key issues in health services policy and management. 3. San Francisco, CA: John Wiley & Sons; 2007.
    1. Black BS, Johnston D, Rabins PV, Morrison A, Lyketsos C, Samus QM. Unmet needs of community-residing persons with dementia and their informal caregivers: Findings from the maximizing independence at home study. Journal of the American Geriatrics Society. 2013;61:2087–2095.
    1. Bloom BS, Chhatre S, Jayadevappa R. Cost effects of a specialized care center for people with Alzheimer’s disease. American Journal of Alzheimer’s Disease and Other Dementias. 2004;19:226–232.
    1. Brummel-Smith K, London MR, Drew N, Krulewitch H, Singer C, Hanson L. Outcomes of pain in frail older adults with dementia. Journal of the American Geriatrics Society. 2002;50:1847–1851.
    1. Bynum JP, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW. The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. Journal of the American Geriatrics Society. 2004;52:187–194.
    1. Caspi E, Silverstein NM, Porell F, Kwan N. Physician outpatient contacts and hospitalizations among cognitively impaired elderly. Alzheimer’s & Dementia. 2009;5:30–42. doi: 10.1016/j.jalz.2008.05.2493.
    1. Deb A, Sambamoorthi U, Thornton JD, Schreurs B, Innes K. Direct medical expenditures associated with Alzheimer’s and related dementias (ADRD) in a nationally representative sample of older adults: An excess cost approach. Aging and Mental Health. 2017 doi: 10.1080/13607863.2017.1286454. Advance online publication.
    1. Eaker ED, Mickel SF, Chyou PH, Mueller-Rizner NJ, Slusser JP. Alzheimer’s disease or other dementia and medical care utilization. Annals of Epidemiology. 2002;12:39–45.
    1. Feng Z, Coots LA, Kaganova Y, Wiener JM. Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Affairs. 2014;33:683–690. doi: 10.1377/hlthaff.2013.1179.
    1. Fillit H, Hill JW, Futterman R. Health care utilization and costs of Alzheimer’s disease: The role of co-morbid conditions, disease stage, and pharmacotherapy. Family Medicine. 2002;34:528–535.
    1. Galarraga JE, Mutter R, Pines JM. Costs associated with ambulatory care sensitive conditions across hospital-based settings. Academic Emergency Medicine. 2015;22:172–181. doi: 10.1111/acem.12579.
    1. George J, Long S, Vincent C. How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. Journal of the Royal Society of Medicine. 2013;106:355–361. doi: 10.1177/0141076813476497.
    1. Goodwin JS, Howrey B, Zhang DD, Kuo YF. Risk of continued institutionalization after hospitalization in older adults. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2011;66:1321–1327. doi: 10.1093/gerona/glr171.
    1. Grober E, Sanders A, Hall CB, Ehrlich AR, Lipton RB. Very mild dementia and medical comorbidity independently predict health care use in the elderly. Journal of Primary Care and Community Health. 2012;3:23–28. doi: 10.1177/2150131911412783.
    1. Gruneir A, Silver MJ, Rochon PA. Emergency department use by older adults: A literature review on trends, appropriateness, and consequences of unmet health care needs. Medical Care Research and Review. 2011;68:131–155. doi: 10.1177/1077558710379422.
    1. Hill J, Fillit H, Shah SN, del Valle MC, Futterman R. Patterns of healthcare utilization and costs for vascular dementia in a community-dwelling population. Journal of Alzheimer’s Disease. 2005;8:43–50.
    1. Husaini BA, Sherkat DE, Moonis M, Levine R, Holzer C, Cain VA. Racial differences in the diagnosis of dementia and in its effects on the use and costs of health care services. Psychiatric Services. 2003;54:92–96. doi: 10.1176/appi.ps.54.1.92.
    1. LaMantia MA, Stump TE, Messina FC, Miller DK, Callahan CM. Emergency department use among older adults with dementia. Alzheimer’s Disease and Associated Disorders. 2015;30:35–40. doi: 10.1097/wad.0000000000000118.
    1. Leibson CL, Long KH, Ransom JE, Roberts RO, Hass SL, Duhig AM, … Petersen RC. Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population-based study. Alzheimer’s and Dementia. 2015;11:917–932. doi: 10.1016/j.jalz.2015.01.007.
    1. Leon J, Neumann PJ, Hermann RC, Hsu M, Cummings JL, Doraiswamy PM, Marin D. Health-related quality-of-life and service utilization in Alzheimer’s disease: A cross-sectional study. American Journal of Alzheimer’s Disease & Other Dementias. 2000;15:94–108.
    1. Litzelman DK, Inui TS, Griffin WJ, Perkins A, Cottingham AH, Schmitt-Wendholt KM, Ivy SS. Impact of community health workers on elderly patients’ advance care planning and health care utilization: Moving the dial. Medical Care. 2017;55:319–326. doi: 10.1097/mlr.0000000000000675.
    1. McCormick WC, Hardy J, Kukull WA, Bowen JD, Teri L, Zitzer S, Larson EB. Healthcare utilization and costs in managed care patients with Alzheimer’s disease during the last few years of life. Journal of the American Geriatrics Society. 2001;49:1156–1160.
    1. Medicare Payment Advisory Committee. Measuring quality of care in Medicare: Feasibility of measuring population-based outcomes: Potentially preventable admissions and emergency department visits. 2014 Retrieved from .
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and metaanalyses: The PRISMA statement. PLoS Medicine. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Moore JR, Sullivan MM. Enhancing the ADMIT Me tool for care transitions for individuals with Alzheimer’s disease. Journal of Gerontological Nursing. 2017;43(5):32–38. doi: 10.3928/00989134-20170112-01.
    1. Naylor MD. Advancing high value transitional care: The central role of nursing and its leadership. Nursing Administration Quarterly. 2012;36:115–126. doi: 10.1097/NAQ.0b013e31824a040b.
    1. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA. 1999;281:613–620.
    1. Ng S, Morgan RO, Walder A, Biswas J, Bass DM, Judge KS, … Kunik ME. Functional decline predicts emergency department use in veterans with dementia. American Journal of Alzheimer’s Disease and Other Dementias. 2014;29:362–371. doi: 10.1177/1533317513518655.
    1. Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307:165–172. doi: 10.1001/jama.2011.1964.
    1. Richards KM, Shepherd MD, Crismon ML, Snyder EH, Jermain DM. Medical services utilization and charge comparisons between elderly patients with and without Alzheimer’s disease in a managed care organization. Clinical Therapeutics. 2000;22:775–791.
    1. Sadak T, Foster Zdon S, Ishado E, Zaslavsky O, Borson S. Potentially preventable hospitalizations in dementia: Family caregiver experiences. International Psychogeriatrics. 2017;29:1201–1211. doi: 10.1017/s1041610217000217.
    1. Sloane PD, Schifeling CH, Beeber AS, Ward KT, Reed D, Gwyther LP, … Zimmerman S. New or worsening symptoms and signs in community-dwelling persons with dementia: Incidence and relation to use of acute medical services. Journal of the American Geriatrics Society. 2017;65:808–814. doi: 10.1111/jgs.14672.
    1. Tian H, Abouzaid S, Sabbagh MN, Chen W, Gabriel S, Kahler KH, Kim E. Health care utilization and costs among patients with AD with and without dysphagia. Alzheimer’s Disease and Associated Disorders. 2013;27:138–144. doi: 10.1097/WAD.0b013e318258cd7d.
    1. Toseland RW, McCallion P, Gerber T, Banks S. Predictors of health and human services use by persons with dementia and their family caregivers. Social Science Medicine. 2002;55:1255–1266.
    1. U.S. Department of Health and Human Services. National plan to address Alzheimer’s disease: 2014 update. 2014 Retrieved from .
    1. Viswanathan M, Berkman ND, Dryden DM, Hartling L. Assessing risk of bias and confounding in observational studies of interventions or exposures: Further development of the RTI Item Bank. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
    1. Weber SR, Pirraglia PA, Kunik ME. Use of services by community-dwelling patients with dementia: A systematic review. American Journal of Alzheimer’s Disease and Other Dementias. 2011;26:195–204. doi: 10.1177/1533317510392564.
    1. Zhao Y, Kuo TC, Weir S, Kramer MS, Ash AS. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Services Research. 2008;8:108. doi: 10.1186/1472-6963-8-108.

Source: PubMed

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