Dementia profoundly affects decision making in emergencies by impairing cognitive functions essential for rapid, accurate judgments. In emergency situations, individuals with dementia face challenges in processing information, understanding risks, and communicating their needs, which complicates timely and appropriate responses.
Dementia is a progressive neurological condition characterized by decline in memory, reasoning, attention, and executive functions. These cognitive domains are critical for decision making, especially under pressure. In emergencies, decisions often need to be made quickly, sometimes within seconds, and require the ability to assess complex information, weigh options, and anticipate consequences. Dementia disrupts these abilities by causing confusion, impaired judgment, and reduced problem-solving skills.
One key impact of dementia on emergency decision making is the difficulty in understanding the situation and the urgency involved. People with dementia may not fully grasp the nature of the emergency or the potential severity of their condition. This can lead to delayed or inappropriate responses, such as refusing help or not following instructions from emergency responders or caregivers. Their impaired memory and attention make it hard to recall important medical history or current medications, which are vital for emergency medical personnel to make informed decisions quickly.
Communication barriers are another significant issue. Dementia often affects language skills, making it difficult for individuals to express symptoms, pain levels, or preferences clearly. This can result in misunderstandings or incomplete information being conveyed to healthcare providers, which may lead to suboptimal treatment decisions. Emergency responders and medical staff must rely more heavily on caregivers or medical records, which may not always be immediately available.
In emergency departments, specialized approaches are needed to accommodate the unique needs of patients with dementia. For example, interventions like the GAPcare program have been adapted to reduce fall-related emergency visits among people living with dementia by incorporating pharmacy and physical therapy consultations tailored to their cognitive abilities and living situations. Such adaptations recognize that dementia patients require more personalized care plans that consider their cognitive limitations and support systems [2].
Moreover, emergency care providers are increasingly encouraged to engage in shared decision making that includes the patient’s caregivers and considers what matters most to the patient. Asking patients with dementia about their priorities, when possible, can guide more meaningful and individualized care even in urgent settings. This approach helps balance the need for rapid decisions with respect for the patient’s values and preferences [3].
Technological advances, such as AI decision-support tools, are also being explored to assist emergency medical providers in making better decisions when treating complex cases, including those involving cognitive impairments. These tools synthesize critical patient information and provide treatment recommendations in real time, potentially improving diagnostic accuracy and treatment outcomes without delaying care [1].
Delirium, a common acute condition that often co-occurs with dementia, further complicates emergency decision making. It affects up to 38% of older adults in emergency departments and is frequently underrecognized. Delirium can cause sudden confusion and fluctuating consciousness, making it even harder for patients to participate in decisions or communicate effectively. Early identification and management of delirium are crucial to improving outcomes for dementia patients in emergencies [8].
Emergency admissions related to dementia crises are increasing, often driven by the need for 24-hour care and the inability to live independently. These crises destabilize regular care routines and require urgent decisions about hospitalization, treatment, and long-term care planning. The complexity of these decisions is heightened by cognitive impairment, necessitating coordinated efforts among emergency staff, dementia care specialists, and caregivers [7].
Programs like the GUIDE Model aim to improve the dementia experience by providing comprehensive services that help people with dementia remain safely in their homes longer, potentially reducing emergency situations. Such models emphasize proactive care and support to prevent crises that demand urgent decision making [4].
Telemedicine is emerging as a promising tool to support dementia care, including in emergencies. It can facilitate timely consultations with dementia specialists and caregivers, improving decision making when immediate in-person assessment is challenging [6].
In summary, dementia affects emergency decision making by impairing cognitive functions essential for understanding, communication, and judgment. Emergency care for people with dementia requires tailored interventions, involvement of caregivers, use of decision-support technologies, and awareness of complicating factors like delirium. These strategies aim to improve the quality and safety of emergency care for this vulnerable population.
Sources:
[1] Drexel University study on AI in emergency care, MedicalXpress, 2025
[2] Adaptation of GAPcare intervention for dementia patients in ED, Nature Scientific Reports, 2025
[3] Asking “what matters most” in older ED patients, PMC, 2025
[4] CMS GUIDE Model for dementia care, CMS.gov, 2024
[6] WHO study on telemedicine in dementia care, WHO, 2025
[7] Dementia-related crisis admissions, Tandfonline, 2025
[8] Delirium risk in emergency departments, JAMA Network Open, 2025
