High-Intensity Telemedicine Reduces Emergency Department Use by Older Adults With Dementia in Senior Living Communities

J Am Med Dir Assoc. 2019 Aug;20(8):942-946. doi: 10.1016/j.jamda.2019.03.024. Epub 2019 Jul 15.


Objectives: Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. We evaluated the effect of a high-intensity telemedicine program that delivers care for acute illnesses on ED use rates for individuals with dementia who reside in senior living communities (SLCs; independent and assisted living).

Design: We performed a secondary analysis of data for patients with dementia from a prospective cohort study over 3.5 years that evaluated the effectiveness of high-intensity telemedicine for acute illnesses among SLC residents.

Setting and participants: We studied patients cared for by a primary care geriatrics practice at 22 SLCs in a northeastern city. Six SLCs were selected as intervention facilities and had access to patient-to-provider high-intensity telemedicine services to diagnose and treat illnesses. Patients at the remaining 15 SLCs served as controls. Participants were considered to have dementia if they had a diagnosis of dementia on their medical record problem list, were receiving medications for the indication of dementia, or had cognitive testing consistent with dementia.

Measures: We compared the rate of ED use among participants with dementia and access to high-intensity telemedicine services to control participants with dementia but without access to services.

Results: Intervention group participants had 201 telemedicine visits. In participants with dementia, it is estimated that 1 year of access to telemedicine services is associated with a 24% decrease in ED visits (rate ratio 0.76, 95% confidence interval 0.61, 0.96).

Conclusions/implications: Telemedicine in SLCs can effectively decrease ED use by individuals with dementia, but further research is needed to confirm this secondary analysis and to understand how to best implement and optimize telemedicine for patients with dementia suffering from acute illnesses.

Keywords: Telemedicine; acute illness; assisted living; dementia; telehealth.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Dementia / therapy*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Homes for the Aged*
  • Humans
  • Male
  • Prospective Studies
  • Telemedicine*