From an ER Nurse: 7 Reasons People With Dementia End Up in the Emergency Department and How to Prevent Them

A trip to the Emergency Department is sometimes necessary, but for people living with dementia, it’s not something to take lightly. As an ER nurse, I know hospitalizations can be life-changing events. They disrupt routines, expose patients to unfamiliar environments, and can accelerate confusion or functional decline.

Research supports what caregivers and clinicians already know: people living with dementia are far more likely to end up in the ER than their peers. A 2023 study from the Journal of the American Medical Association Neurology found that nearly one in four older adults with dementia visited an Emergency Department each year, most often for accidents, infections, or sudden changes in mental status.¹ In another study from the Journal of the American Geriatrics Society, two-thirds of these patients had at least one return visit within a year.² Each visit increases the risk of delirium, loss of independence, and further hospitalization.

During my seven years in the ER, I’ve seen these patterns play out countless times. The good news is that many of these visits are preventable. With early recognition, clear communication, and stronger outpatient support, families can often address issues before they become emergencies.

The following are some of the most frequent reasons people living with dementia come to the ER, along with practical steps to help prevent them no matter where someone is in their dementia journey.

1. Undetected Infections

Urinary tract infections and pneumonia are among the leading causes of ER visits in people with dementia. However, the presentation is often atypical. Instead of fever or localized pain, the first signs may be subtle changes in mental status, such as increased confusion, agitation, or lethargy.

Prevention strategies:

• Encourage consistent hydration and monitor for decreased urine output or dark urine.

• Stay current with vaccinations, including influenza, pneumococcal, and COVID-19 boosters.

• Identify sudden behavioral changes as possible early signs of infection and contact a healthcare provider promptly for assessment.

• Build a strong relationship with their primary care provider. A clinician who knows the patient’s usual behavior and communication patterns can often identify early changes before they require hospitalization.

  
  

2. Falls and Resulting Injuries

Falls are a major cause of emergency visits among older adults, and people with dementia are more than twice as likely to visit the ED for an accident compared to those without dementia.¹ Balance issues, medication side effects, and visual or environmental hazards all play a role. Even when injuries appear minor, falls can trigger a lasting loss of confidence and mobility.

Prevention strategies:

• Remove clutter, secure loose rugs, and ensure adequate lighting, especially at night.

• Encourage regular movement and exercise to maintain strength and balance.

• Review medications for potential side effects such as dizziness or sedation.

• Install grab bars and ensure footwear is supportive and non-slip.

• Some insurance plans or local care agencies may even cover the cost of safety equipment such as grab bars, shower chairs, and raised toilet seats. These small adjustments can greatly reduce fall risk.

3. Medication Errors

Medication mismanagement, including missed doses or accidental double dosing, is another frequent reason for ER visits. Up to two-thirds of older adults with dementia have at least one adverse drug reaction or interaction, often due to complex medication regimens.³

Prevention strategies:

• Use a pill organizer or automated medication dispenser.

• Keep an up-to-date medication list and share it with everyone supporting with care.

• Simplify regimens whenever possible, reducing the number of daily doses.

• Assign one caregiver to support with medication administration to avoid duplication.

• Engage a pharmacist for a medication review. Pharmacists can identify drug interactions, simplify schedules, and suggest cost-saving alternatives. Ask your primary care provider or the pharmacist for assistance the next time a prescription is filled.

4. Dehydration and Poor Nutrition

Dehydration and inadequate nutrition can occur gradually and may go unnoticed until they lead to fatigue, confusion, or acute illness requiring emergency care.

Prevention strategies:

• Offer fluids throughout the day, even if the person does not ask.

• Incorporate hydrating foods such as fruit, soups, yogurt, or milkshakes.

• If the use of utensils is a barrier, encourage independence by offering foods that don't require cutlery, like sandwiches.

• Make meals social whenever possible; individuals tend to eat better in company.

• Watch for signs such as dry mouth, constipation, or reduced alertness.

• Eating may also be uncomfortable or challenging for other reasons. Make sure dentures fit well and schedule regular visits to the dentist.

• Speak to your primary care provider if weight loss or poor appetite becomes a concern. They may prescribe an appetite stimulant or a referral to a dietician.

5. Sudden Confusion or Behavior Change

When a person with dementia experiences a rapid shift in awareness, mood, or personality, it often reflects an underlying medical issue such as infection, dehydration, pain, or a medication side effect. In clinical terms, this is delirium, a condition that warrants prompt evaluation. Unlike the chronic, progressive decline in memory associated with dementia that can develop over months and years, delirium has a rapid onset and is often reversible once the underlying cause is addressed.

Prevention strategies:

• Document when the change began and what else may have changed during that time (e.g., new medications, environments, sleep patterns, or diet).

• Provide a calm, familiar environment to minimize distress.

• Contact a healthcare provider early to identify and address the underlying cause.

• Regular follow-up visits with a consistent primary care provider make it easier to track subtle cognitive or functional changes before they escalate.

6. Caregiver Fatigue and Crisis

Caring for someone with dementia is a demanding, full-time responsibility. When caregivers reach a point of exhaustion or emotional distress, the emergency department sometimes becomes the only option, not because of a medical crisis, but because the family has run out of support.

Prevention strategies:

• Seek respite care, adult day programs, or home health services early, not only when exhaustion sets in.

• Establish a network of support among friends, family, and community organizations.

• Ask a primary care provider or social worker for care-coordination resources; they can help connect you with services covered by insurance or community grants.

• Remember that sustaining the caregiver’s well-being is essential to sustaining the care recipient’s stability.

7. Wandering and Elopement

Wandering, where a person may unintentionally leave a safe environment, is common among individuals with dementia and can be frightening for families. It often results from disorientation, anxiety, or the desire to return to a familiar place.

Prevention strategies:

• Use discreet door alarms or motion sensors that maintain dignity and independence.

• Ensure the individual wears identification, carries a medical alert device, or uses smartphone-based location tracking.

• Establish predictable routines and provide structured activities to reduce restlessness.

• Notify local authorities or let your neighbors know to keep an eye out if wandering has occurred in the past.

Conclusion

Hospital visits are sometimes unavoidable, but many can be prevented through proactive care, early recognition, and close collaboration with healthcare professionals. Building a strong, trusting relationship with the primary care provider is one of the most effective ways to keep people with dementia safe and stable at home.

Pharmacists, dietitians, and social workers are also valuable and often underused members of the care team. They can review medications, recommend home safety equipment, and connect families with supportive programs frequently covered by insurance.

For people living with dementia, avoiding unnecessary hospitalizations is not just about staying healthy and avoiding hospital bills; it’s about preserving comfort, familiarity, and independence.

With the right support network and a proactive approach, many crises can be prevented, allowing individuals to remain in the environment where they feel most at ease: home.

Sources:

1. LaMantia MA et al. Characteristics of Emergency Department Visits Among Older Adults With Dementia. JAMA Neurology. 2023.

2. Brousseau A-A et al. Repeat Emergency Department Visits Among Older Adults With Dementia. Journal of the American Geriatrics Society. 2022.

3. Gustafsson M et al. Drug-related problems among the elderly with dementia. BMC Pharmacology & Toxicology. 2017.