Steep Jump in Dementia Patient ED Visits Tied to Caregiver Depression

Megan Brooks

July 10, 2019

Caregiver depression is tied to skyrocketing rates of emergency department (ED) visits in patients with dementia, new research shows.

In a large observational study, caregiver depression was associated with a 73% increase in the rate of ED use among patients with dementia.

"Depression is incredibly common among those who care for family members with dementia. This takes a toll on the quality of life of these caregivers, but we know less about the relationship between caregiver health and healthcare use for patients with dementia," study investigator Elan Guterman, MD, assistant professor of clinical neurology, University of California, San Francisco, told Medscape Medical News.

"This study provides evidence that caregiver depression is associated with ED use and suggests that we need to do a better job supporting caregivers," said Guterman.

The study was published online July 8 in JAMA Neurology.

More Support Needed

The researchers studied 663 caregivers (mean age, 65 years; 467 women) and their patients with dementia. They found that 84 (12.7%) of the caregivers had depression at baseline and this was associated with an increase in rates of ED visits by patients.

Over 6 months, 196 patients with dementia had at least one ED visit. Caregiver depression was associated with an additional 0.7 ED visits per person-year for patients compared with non-depressed caregivers (1.5 vs. 0.8 visits).

After adjusting for patient age, sex, severity of dementia, number of comorbidities, and baseline ED use, as well as caregiver age and sex, caregiver depression was associated with a 73% increase in rates of ED use among patients with dementia (adjusted incident rate ratio, 1.73; 95% confidence interval [CI], 1.30 - 2.30).

The results reveal a "key caregiver vulnerability, which, if addressed with patient- and caregiver-centered dementia care, could improve health outcomes and lower costs for this high-risk population," the investigators write.

"Caregivers are fundamental to the model of dementia care that we have developed in this country," Guterman said. "We rely on spouses, children, and other informal caregivers to support a variety of complex needs. As a medical community, we can do a much better job supporting these dedicated family members and friends in that effort," said Guterman.

"It would be fantastic to have greater attention be paid to caregivers at routine office visits, but we have to think about other sustainable solutions to mitigate caregiver depression and improve the quality of dementia care nationally," said Guterman.

"Devastating" Caregiver Toll

Commenting on the study for Medscape Medical News, Ruth Drew, MS, LPC, director of information and support services for the Alzheimer's Association, said this study "underscores what we see and hear every day — Alzheimer's takes a devastating toll on caregivers. Caregiving is hard, and can lead to feelings of stress, guilt, anger, sadness, isolation, and depression."

"In many ways, it is not surprising that a caregiver who is feeling overwhelmed and suffering depression may be quicker to turn to the local emergency department for help," she added.

The study findings pave the way for additional research to explore what effect managing a caregiver's depression may have on the healthcare decisions they make, said Drew.

Drew said that, based on personal experience, she finds that caregivers who take care of themselves are better able to tend to the needs of others.

"It can be easy for caregivers to focus so much on the ever-increasing care needs of their loved one that they inadvertently lose sight of the fact that their own health is an important part of the caregiver equation," said Drew. "Staying healthy includes regular medical care, rest, nutrition, and the connection and support of others. If a caregiver is not healthy, it's really difficult to provide optimal care to others."

Drew said no one should go through caring for someone with Alzheimer's disease alone — and with an abundance of support systems available, no one has to.

"It's really important for caregivers to access all available resources and seek the help of others," she said.

"Connecting with other caregivers and support organizations can help you find the information, resources and emotional support needed to help stay physically and emotionally strong so you can take care of yourself while you provide care to others."

The study was funded by grants from the Centers for Medicare & Medicaid Services, the National Institute on Aging, the Administration for Community Living, and the Global Brain Health Institute. Guterman and Drew have disclosed no relevant financial relationships.

JAMA Neurol. Published online July 8, 2019. Abstract

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