The COVID-19 pandemic revealed devastating cracks in the foundation of U.S. health care. Hospitals were unprepared for enormous challenges to staffing, resulting from burnout and absences caused by the medical and psychological costs of the coronavirus.

There is another emerging crisis that could catch us again unprepared and last for decades: hospital emergencies stemming from dementia.

As the baby boomer population ages, more Americans will need hospitalizations and suffer from dementia. An estimated one in three seniors die with the condition.

Older patients, particularly those with dementia, can become very confused and agitated when critically ill. They may sometimes act in ways that risk immediate harm to themselves or others, called a “behavioral emergency” in hospital medicine. These kinds of hospital emergencies are generally perceived as “violence” and countered with security force, the same response given to intentional, nonmedical safety threats. This often results in elderly patients being physically restrained while hospitalized. Restraints disrupt and decrease the quality and efficiency of their care — contributing to a financial drain on hospital systems and rising insurance premiums by clogging hospital beds and resources, and hastening provider burnout.

Hospitals already have medical rapid response teams: clinical specialists from multiple fields who are trained to respond together to medical crises, including heart attacks, strokes and lung failures. But shockingly, most hospitals nationwide do not have an emergency protocol to treat behavioral emergencies — whether from psychiatric illness, dementia agitation or medical disorientation — any differently than they would confront security threats. Instead of having access to psychiatric equivalents of medical rapid response teams, most care providers can only respond to behavioral emergencies by seeking security assistance.

There are well-researched, patient-centered protocols for handling behavioral emergencies. These approaches are just not prioritized in the United States.

Psychiatric equivalents to medical rapid response teams, frequently called behavioral emergency response teams, or BERTs, prioritize patient-centered care and provider safety by immediately mobilizing a team of specialists. Their first step is minimizing patient and provider injury through de-escalation. As patients become calmer, primary hospital teams begin the second step of investigating the medical reasons contributing to their distress.

American hospitals should be preparing for the foreseeable challenges of dementia.

Carmen Black is an assistant professor of psychiatry at Yale University.