Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

Dresden, Scott M.; Taylor, Zachary; Serina, Peter; Kennedy, Maura; Wescott, Annie; Hogan, Teresita M.; Shah, Manish N.; Hwang, Ula

doi:10.1016/j.jamda.2022.05.024

Cited by 21 publications

(20 citation statements)

References 68 publications

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“…A step towards giving dementia due esteem could start with the ED. There have already been advances to care practices in the ED for people with dementia, including dementia inclusive bays and communication tools 38 . However, priority areas identified in this study included improved ergonomics for people with reduced cognitive reserve, including clear signage and quiet areas; improved communication from staff that is respectfully sensitive to the needs of individuals with dementia; reduced time to assessment to avoid worsening anxiety; consideration of community‐based investigations to avoid admission where possible; and being accompanied by a family caregiver or familiar other.…”

Section: Discussionmentioning

confidence: 99%

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

Williamson

Sleeman

Evans

2023

Int J Geriat Psychiatry

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Objectives: Emergency department (ED) attendance is common among people with dementia and associated with poor health outcomes. Literature suggests a link between access to community care and the ED, but we know little about the mechanisms behind this link. This study aimed to explore experiences of accessing community and emergency care among people affected by dementia.Methods: Informed by critical realism, semi-structured online and telephone interviews were conducted with people with dementia and family caregivers, with and without experience of using the ED. Participants were recruited from across the United Kingdom using purposive sampling with maximum variation. A mostly experiential reflexive thematic analysis approach was used, applying the candidacy model of access to deepen interpretation.Results: Two dyad and 33 individual interviews were conducted with 10 people with dementia, 11 current caregivers and 16 bereaved caregivers (men = 11, 70-89 years = 18, white ethnicity = 32). Three themes are reported: (1) Navigating a 'push system', (2) ED as the 'last resort', and (3) Taking dementia 'seriously'. Themes describe a discrepancy between the configuration of services and the needs of people affected by dementia, who resort to the ED in the absence of accessible alternatives. Underlying this discrepancy is a lack of systemic prioritisation of dementia and wider societal stigma. Conclusion:Although a last resort, ED attendance is frequently the path of least resistance for people with dementia who encounter multiple barriers for timely, responsive access to community health and social care. Greater systemic prioritisation of dementia as a life-limiting condition may help to reduce reliance on the ED through essential development of post-diagnostic care, from diagnosis to the end of life.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

Williamson

Sleeman

Evans

2023

Int J Geriat Psychiatry

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“…Through a rigorous process, they identified and prioritized research gaps in the emergency care of PLWD 4 . The four priority areas identified included (1) detection of ED patients with impaired cognition, 5 (2) communication and decision‐making with PLWD and their care partners, 6 (3) care transitions for ED patients with impaired cognition, 7 and (4) clinical best practices in the ED setting for PLWD 8 . The workgroup then performed a scoping review for each topic and developed specific questions within each area that would have the greatest impact on PLWD 5–8 .…”

Section: Figurementioning

confidence: 99%

“…The four priority areas identified included (1) detection of ED patients with impaired cognition, 5 (2) communication and decision‐making with PLWD and their care partners, 6 (3) care transitions for ED patients with impaired cognition, 7 and (4) clinical best practices in the ED setting for PLWD 8 . The workgroup then performed a scoping review for each topic and developed specific questions within each area that would have the greatest impact on PLWD 5–8 . GEAR 2.0‐ADC is now awarding $1.1 million in pilot research funding (using financial support from the NIH, the West Health Institute, and the Emergency Medicine Foundation) over 3 years to address these priority areas and questions.…”

Section: Figurementioning

confidence: 99%

Recurrent emergency department visits among persons living with dementia: Bending the curve

Shah,

Hwang

2023

J American Geriatrics Society

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“…ED discharge care transitions have been prioritized within the 2014 Geriatric ED Guidelines 1 and the 2018 launch of the American College of Emergency Physicians geriatric ED accreditation process. 14 Recent ED-centric initiatives, as part of the Geriatric Emergency care Applied Research 2.0 Network -Advancing Dementia Care, [15][16][17][18] identified the need for the development of patient-and care partner-reported outcome measures that capture what matters most to stakeholders during ED care transitions. 6,9 As a first step toward developing a novel care partner-reported outcome measure, we sought to assess the barriers experienced by care partners of PLWCI during ED discharge care transitions.…”

Section: Introductionmentioning

confidence: 99%

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Gettel

Serina

Uzamere

et al. 2022

A&D Transl Res & Clin Interv

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INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner‐completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi‐structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners’ mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner‐reported outcome measures as well as ED discharge care transition interventions targeting care partners.

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Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

Cited by 21 publications

References 68 publications

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

Recurrent emergency department visits among persons living with dementia: Bending the curve

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

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