170 Emergency Department Chief Complaints Among Older Adults With and Without Alzheimer’s Disease or Related Dementias in Years Before and After Diagnosis

Abstract

The Emergency Department (ED) is a common site of care for older adults including those with Alzheimer’s disease and Related Dementias (ADRD). Chief complaints may provide valuable early information to hasten triage, diagnostic workup, and care; however, studies have been limited in ADRD. We characterized chief complaints of patients with and without ADRD presenting to the ED in the years prior to and after diagnosis. This was a retrospective observational analysis of the chief complaints of Medicare beneficiaries who received care within the ED at two large healthcare systems in New York, NY and Chicago, IL over a six-year period (2010-2015). ED visit encounter data from electronic health records (EHRs) of both healthcare systems were linked to beneficiary Medicare Fee-for-service claims. Chief complaints were abstracted from EHRs and grouped into 82 different categories. We identified diagnosis of ADRD through ICD diagnoses in inpatient and outpatient claims and ADRD-related prescriptions. We report the prevalence of each chief complaint category among beneficiaries with ADRD, before and after ADRD diagnosis, and at each ED location. We identified 57,204 Medicare beneficiaries who had a total of 151,053 ED visits across the two hospital systems over the 6-year period. One in four patients (N=14,991; 25.3%) had a diagnosis of ADRD or received ADRD-related prescription during the observation period. These patients accounted for 31.8% of all ED visits (12.4% prior to diagnosis; 19.4% after ADRD diagnosis). Among the top 10 chief complaints, altered mental status (4.3% vs. 1.3%), fall (6.4% vs. 4.7%), psychiatric disturbance (2.89% vs. 1.69%), and weakness (4.3% vs. 3.1%) were more common among patients with ADRD compared to beneficiaries without ADRD. On the contrary, chief complaints of any pain (9.9% vs. 7.1%), chest pain (7.7% vs. 4.6%), abdominal related (6.1% vs. 4.4%), and dizziness (2.9% vs. 2.0%) were more common among non-ADRD patients. These differences were observed up to 2 years prior to diagnosis with an increase in number and percentage of ED visits with chief complaints of alerted mental status, falls, and weakness in the 6 months prior to diagnosis of ADRD. These patterns were consistent across sites. Patients with ADRD and cognitive impairment encompass a significant portion of older adults presenting to the ED. Chief complaints of patients with ADRD are more likely to present with geriatric syndromes and altered mental status, even before diagnosis is documented. Chief complaints may be a feasible way to recognize and triage older adults to geriatric and ADRD services needed to foster higher quality ED and post-ED care.