Nearly half of long-term skilled nursing facility (SNF) residents end up in the hospital emergency department (ED) at least once a year, but those with advanced dementia aren’t usually first in line, suggests new data from the Regenstrief Institute and the Indiana University Center for Aging Research.
In "Patterns of Emergency Department Use Among Long-Stay Nursing Home Residents with Differing Levels of Dementia Severity,” published in JAMDA online, researchers discovered the average number of days between SNF move-in and the first ED visit was 202 days for those with no dementia, 250 days for moderate dementia and 258 days for those with advanced dementia.
Among the 4,491 seniors in the cohort study, residents with severe cognitive loss also had fewer comorbidities and chronic disease complications than other residents. This, the study authors wrote, "may suggest that long-stay nursing home residents with advanced dementia are ‘survivors’ who are healthy enough to have lived long enough to develop advanced dementia."
SNFs need to work harder to understand the care needs that often lead to ED calls, the study noted. Only one-third of ED visits resulted in hospital admissions, another element that suggests at least some ED visits are unnecessary. But, many residents who transfer to the ED are diagnosed with urinary tract infections, a condition considered highly preventable.
"Identifying unnecessary transfers of nursing home patients to the hospital continues to be a high priority for policymakers, researchers and clinicians," said Indiana University Center for Aging Research and Regenstrief Institute investigator Kathleen Unroe, MD, MHA, senior author of the study. "We need to deliver patient-centered and directed care in the most appropriate setting. This study describes high rates of transfers to the hospital in a frail population; more work needs to be done to understand which of these transfers can be avoided."