Telemedicine Can Reduce ED Visits for People with Dementia
Though older adults with dementia have high rates of emergency department use for acute illnesses, a trip to the ED can be disruptive for them as they are at greater risk for delirium and other hazards. A recent University of Rochester Medical Center trial found that telemedicine can be an effective tool for providing timely care while reducing emergency department visits for this growing population.
Led by geriatrics experts Suzanne M. Gillespie, M.D. R.D., and Dallas Nelson, M.D., “High-Intensity Telemedicine Reduces Emergency Department Use by Older Adults with Dementia in Senior Living Communities” was published online in July in JAMDA, the Journal of Post-Acute and Long-Term Care Medicine.
The study resulted from a project launched several years ago to offer telemedicine evaluations for urgent health concerns in Rochester-area senior living communities. Established protocols for common conditions—such as pain, shortness of breath, or skin issues—allowed for prompt evaluations and referrals as needed.
“This study took our existing program a step further, to see if telemedicine could make a difference for individuals in those communities who have dementia and need care urgently,” Nelson said.
Researchers looked at 22 senior living centers in Greater Rochester served by URMC’s geriatrics group, selecting six of them as intervention facilities. As urgent care needs arose, older adults living in those centers and receiving primary care from the geriatrics group could contact the geriatrics practice and have access to urgent care via telemedicine. Information was tracked to determine whether or not access to telemedicine reduced their need to use an emergency department.
During the study, 220 participants had access to telemedicine care and 201 telemedicine visits were conducted. Results showed that a year of access to telemedicine was associated with 24 percent reduction in ED visits.
“This is a population that tends not to be able to engage in health care as others would—they don’t drive and depend on other means of transportation to office visits, and when they have urgent need for medical care it can be difficult for them to navigate access to care or easily describe their history and needs. Coming to them makes a difference; it improves their access to quality care,” Gillespie said.
“These results confirm that telemedicine is feasible, even for people with cognitive impairment, and that it can effectively decrease emergency department use by those individuals,” she said.
“This has implications both for health outcomes and for health care costs,” Nelson added. “It opens the door to another important tool we can use as we build the arsenal of approaches to give good quality, cost-effective care to this expanding population.”
It’s estimated that 5.8 million people in the U.S. are living with dementia. That number is expected to triple in the next 30 years.
“Future research is needed to confirm our findings and examine changes in the overall cost of health care delivered to this population,” Gillespie said. “The Alzheimer’s Association estimates that $290 billion is spent caring for people with dementia. It’s contingent on us as a society to determine how we use our resources thoughtfully and cost effectively, and our geriatrics group is trying to lead the way through initiatives such as this.”
Gillespie points to a demonstration project using telemedicine in nursing homes to provide access to around-the-clock provider assessments as a tool for understanding financial implications and potential cost savings.
“We are working to dialogue on how to expand this into senior living centers,” she said.
In addition to JAMDA, the research was presented at the Alzheimer’s Association International Conference 2019 in Los Angeles.
The study was supported by funds from the Agency for Healthcare Research and Quality and the U.S. National Institute on Aging.
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