Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs

Jacobsohn, Gwen Costa; Hollander, Matthew M.; Beck, Aaron P; Gilmore‐Bykovskyi, Andrea; Werner, Nicole E.; Shah, Manish N.

doi:10.1111/jgs.15737

Cited by 27 publications

(29 citation statements)

References 48 publications

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“… 42 45 General practitioners (GPs) were reported to find behavioural symptoms in care homes as the most challenging part of their job, 45 with patients with dementia seen as a burden on time. 53 62 …”

Section: Resultsmentioning

confidence: 99%

“…Emergency department staff had specific challenges related to the time-pressured environment, where the focus was on the acute presenting problem rather than dementia. 53 62 64 65 This could be compounded by the presence of delirium. 64 Dementia could also make it harder for staff to identify the reason for visiting the emergency department, which lead to undertriaging and longer waiting times for patients.…”

Section: Resultsmentioning

confidence: 99%

“…56 Carers' lack of knowledge about how to recognise and manage healthcare situations, and what the treatment options were, lead to increased urgent care use. 53 Additionally, as the situation escalates, caregivers may be under pressure to make decisions quickly, leading to inappropriate care. 56 Caregiver education and counselling was therefore reported to be key in reducing urgent care use and providing support for caregivers to manage changes in symptoms appropriately.…”

Section: Open Accessmentioning

confidence: 99%

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Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

et al. 2020

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ObjectivesPeople with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.DesignScoping review. The search strategy and data synthesis were informed by people with dementia and carers.Data sourcesSearches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.Eligibility criteriaEmpirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.Data extraction and synthesisData were extracted using charting techniques and findings were synthesised according to content and themes.ResultsOf 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.ConclusionsThe scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

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Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

et al. 2020

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“…It was a course of action reported by 64% (506) of carers of people with Lewy Body Dementia in USA who completed a survey, with subsequent in-patient psychiatric care given in more than 1 in 10 ( Galvin et al, 2010). Help may be sought from an emergency department because people involved in the crisis do not know about alternative options (Jacobsohn et al, 2019).…”

Section: What Happens During Crisismentioning

confidence: 99%

What happens before, during and after crisis for someone with dementia living at home: A systematic review

Hopkinson¹,

King²,

Mullins

et al. 2020

Dementia

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BackgroundPeople living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. MethodsThe protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library, and references of retrieved publications, identified empirical research in English language and date range 1/2000 to 2/2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. ResultsThe search identified 2,755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that:For a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly.Medical treatment, community resources, and psychosocial support of personal resources, decision making, relationships, and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers' and professionals' knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. ConclusionThere has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment.

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“…Nonetheless, paramedics are required to decide whether the patient can be safely treated and managed at home or in the community, or if conveyance to hospital is the most appropriate course of action. This decision may be further complicated if family members or carers express a preference for where the patient should be treated; emergency care is sometimes accessed by informal carers due to 'desperation' for health support [9] and unmet needs [10].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

et al. 2020

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Background: Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process. However, to our knowledge no research has specifically examined the process of decision-making by paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with dementia who did not require immediate clinical treatment. Methods: This qualitative study used a combination of observation, interview and document analysis to investigate the factors influencing the decision-making process during EMS calls to older people with dementia. A researcher worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically. Findings: Four main themes emerged from the data concerning the way that paramedics make conveyance decisions when called to people with dementia: 1) Physical condition; the key factor influencing paramedics' decision-making was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. 3) Patient circumstances; this included the patient's medical history and the support available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from colleagues or information from the patient's General Practitioner, to inform their decision-making. Conclusion: The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for EMS calls to people with dementia.

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Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs

Cited by 27 publications

References 48 publications

Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

What happens before, during and after crisis for someone with dementia living at home: A systematic review

A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

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