Rural Alzheimer’s Patients Lack Adequate Care, Overuse Emergency Departments, Study Finds

Inadequate health supports make people with Alzheimer’s disease living in rural areas more prone to unnecessary emergency department visits than their urban counterparts, a new study from the School of Public Health found. 

The researchers compared the frequency of preventable emergency department (ED) visits by rural older patients with Alzheimer’s disease and related dementias (ADRD) with those of urban patients with ADRD, and found rural patients have 13% higher odds of making such visits, which both increase health care costs and indicate a lack of necessary care.

The research team, led by health policy and management Professor Jie Chen and including Ph.D. candidates Nianyang Wang and Aitalohi Amaize, also reported that hospitals affiliated with Accountable Care Organizations (ACOs) had significantly lower rates of preventable ED visits, according to the study published last month in the Journal of the American Geriatrics Society.

ACOs were created to promote care coordination among doctors, hospitals and other health professionals with the goal of increasing quality of care for Medicare patients while cutting costs. However, the organizations generally haven’t made inroads in rural areas.

Hospitals using the ACO model tend to be “large, urban and have more funding and data for care coordination programs,” the study said. Rural areas, however, are home to a disproportionately large number of adults age 65 and older, and also have greater rates of chronic illnesses than urban areas.

“In addition, rural areas have less access to health care, and in particular, specialists and mental health professionals,” said Wang, the study’s lead author. 

A greater number of ACO-affiliated hospitals in rural communities could not only decrease preventable ED visits, but also reduce urban and rural disparities in overall ADRD care, the researchers wrote.

“A well-designed policy initiative, such as the Accountable Care Organization, can unite the health care and community stakeholders and build a strong public health integrated health care system to promote population health and health equity,” Chen said.

The coronavirus pandemic has only heightened the needs faced by older patients with dementia and their caregivers, highlighting the need for improvements in rural areas in particular, Chen said. 

“Health care integration and coordination among health and social sectors have shown success in building a cost-effective health care delivery system before the pandemic,” she said. “The integration will continue to be the key driver during and post the pandemic.”