Cost of Behavioral Crises Related to Alzheimer's Disease and Related Dementias on First Responder Systems: An Exploratory Study

Enhancing quality of life for people with dementia is identified in Healthy People 2020 as a public health priority. In Idaho, the proportion of individuals diagnosed with Alzheimer's disease and related dementias (ADRD) is projected to increase by 81 % - 127 % between 2000 and 2025. Policies designed to address needs of this population must be based on an understanding of system wide impacts of disease. This study examined costs of behavioral crises associated with ADRD on first responder systems. It was delimited to the most populated region of Idaho and “first responders” were defined as individuals employed in mobile crises, EMS, and health care settings. Information was collected from incident reports from EMS and key informant first responders. All research procedures were approved by the Boise State University Institutional Review Board. EMS receives approximately 22,000 calls annually with 924 of calls related to behavioral crisis involving individuals with ADRD. Most calls were from assisted living facilities (n=401), home (n=290), or skilled nursing facilities (n=181). The majority (80%) of calls resulted in transport to a hospital emergency department (ED); none of the calls required use of lights or siren. Annual costs of calls to EMS and ED were estimated to be $457,380 and $905,020, respectively. Themes from key informants included: an increase in number and complexity of calls; lack of appropriate protocols within systems to support individual in crisis or their family or caregiver; and need for training on progression of ADRD and de-escalation strategies.