Emergency Care for Patients with Dementia

Michelle Lin, MD, MPH, MS, an advocate for comprehensive geriatric care, investigates the accessibility and impact of geriatric emergency departments, aiming to bridge the gap for marginalized populations.

Geriatric emergency departments (EDs) are facilities that support the older population through dedicated care practices like specially trained staff, comprehensive geriatric assessments, environmentally responsive design, care coordination with community resources, medication review, and enhanced communication and decision-making that involves caregivers.

However, there is a potential mismatch between communities in need of geriatric emergency care and those where healthcare innovations, like geriatric EDs, often emerge. While academic hospitals are more likely to provide accredited geriatric care, they may not be easily accessible or geographically proximal to marginalized populations. Dementia is more prevalent in historically marginalized racial and ethnic groups, with evidence suggesting under-treatment and under-diagnosis in these populations.

Lin is exploring the unique challenges and cognitive barriers faced by older adults with dementia in accessing emergency care.

In a national study, Lin is linking geriatric EDs to Medicare data, and then utilizing the demographic information to understand who is accessing the geriatric EDs and whether they are racially and ethnically aligned with the overall US population with dementia.

Lin, associate professor of emergency medicine, is using the American College of Emergency Physicians’s (ACEP) Geriatric Emergency Department Accreditation list to delineate geriatric facilities. Stanford’s Marc and Laura Andreessen Adult Emergency Department has received a Level 2 geriatric accreditation from ACEP.

Lin is also exploring if geriatric EDs are associated with reduced admission rates. Of older adults with dementia, more than half visit the ED every year, and of those, nearly half are hospitalized. Evidence suggests widespread implementation of geriatric EDs has the potential to reduce those hospitalizations by 10%. Lin is determining if ED hospitalization rates at GEDs across the country reflect this practice. It is a data point that is dear to her heart.

Shortly after starting at Stanford, Lin treated a patient with relatively mild dementia who dipped in and out of a confused state but was overall lucid. Lin recalls the patient holding her hand and explained the last time she was in the hospital she had experienced complications. The patient told Lin, “Doctor, please do everything you can to prevent me from having to stay overnight in the hospital again. I don’t have a lot of time left and I want to spend it with my family.” This brief exchange inspired Lin to explore what other older adults faced in similar situations and how the decision-making process could be improved through system changes like GEDS that promote comprehensive, patient-centered geriatric care.

The project is also examining the factors influencing safety net hospitals’ decisions to adopt geriatric EDs. The study aims to understand the connection between the adoption of such programs and the financial resources of institutions. Lin also plans to explore which geriatric-focused interventions make the most difference in improving outcomes, and how even low-resource hospitals can provide impactful care for aging patients with dementia.


Spring 2024