ER rates rise for dementia patients with depressed caregivers

Caring for a loved one with dementia can be overwhelming — physically, mentally, socially and financially.

Researchers at UNMC and University of California San Francisco (UCSF) recently published a study in a major medical journal that found those with dementia had a 73% increased use of the emergency room if their caregivers suffered from depression.

Among the 663 caregivers, 84 (12.7%) had depression when the study started. Emergency room use was higher among those whose caregivers had depression, versus those who did not have depression.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer’s is the most common type of dementia.

Steve Bonasera, M.D., Ph.D., associate professor of geriatrics in the UNMC Department of Internal Medicine Division of Geriatrics, Gerontology, and Palliative Medicine, is one of the authors of the paper published in the Journal of the American Medical Association-Neurology. He was co-investigator of a $10 million grant funded by the Centers for Medicare & Medicaid Innovation with UCSF supporting a study to provide caregivers with tools and information needed to manage the various issues involved in dementia care.

Study participants included 467 women and 196 men with an average age of 65 years who live in California, Nebraska, and Iowa.

“As someone who takes care of patients with dementia, I’m not surprised at the results, but I am surprised they go to emergency rooms almost twice as much as those who aren’t diagnosed with depression,” Dr. Bonasera said. “As a general rule, we found those with dementia go to an emergency room almost one time a year. But for those who have caregivers with depression, we found the number is almost double.”

He said some of the reasons for ER visits include infections and increased confusion and behavior problems.

“We theorize that caregivers who are not depressed can manage better,” he said. “Those who are depressed might not be able to cope well. When caregivers lack the outpatient support or emotional reserve to face the progressively challenging needs of the patient with dementia, the emergency department may present a practical answer. That’s one way a scenario may play out,” he said.

“Caregivers also need to know it’s alright to go to a health professional to say they have trouble coping and if needed, get treated for depression. When we’re looking at treating dementia, it’s not just the patient, but we need to look at the support structure the caregiver relies on and not just the patient.”