Preventing avoidable incidents leading to a presentation to the emergency department (ED) by older adults with cognitive impairment: protocol for a scoping review

Abstract

IntroductionOlder adults with cognitive impairment represent a large portion (21–42%) of people (65+) who consult at an emergency department (ED). Because this sub-group is at higher risk for hospitalisation and mortality following an ED visit, awareness about ‘avoidable’ incidents should be increased in order to prevent presentations to the ED due to such incidents. This study aims to synthetise the actual knowledge related to ‘avoidable’ incidents (ie, traumatic injuries, poisoning and other consequences of external causes) (WHO, 2016) leading to ED presentations in older people with cognitive impairment.Methodology and analysisA scoping review will be performed. Scientific and grey literature (1996–2016) will be searched using a combination of key words pertaining to avoidable incidents, ED presentations, older adults and cognitive impairment. A variety of databases (MEDLINE, CINAHL, Ageline, SCOPUS, ProQuest Dissertations/theses, EBM Reviews, Healthstar), online library catalogues, governmental websites and published statistics will be examined. Included sources will pertain to community-dwelling older adults presenting to the ED as a result of an avoidable incident, with the main focus on those with cognitive impairment. Data (eg, type, frequency, severity, circumstances of incidents, preventive measures) will be extracted and analysed using a thematic chart and content analysis.Discussion and disseminationThis scoping review will provide a picture of the actual knowledge on the subject and identify knowledge gaps in existing literature to be filled by future primary researches. Findings will help stakeholders to develop programmes in order to promote safe and healthy environments and behaviours aimed at reducing avoidable incidents in seniors, especially those with cognitive impairment.

Preventing emergency department (ED) visits and hospitalisations of older adults with cognitive impairment compared with the general senior population: what do we know about avoidable incidents? Results from a scoping review

“…Therefore, some sources may have categorised older adults with mild cognitive impairment or who are undiagnosed as older adults without cognitive impairment. In accordance with the selected design, the quality of the studies was also not assessed, 19 and some pertinent studies may not have been included in this scoping review. Consequently, our conclusion may have been affected by the biases of the included studies.…”

“…Using a research strategy validated by two librarians (FL and KR), scientific and grey literature published in English and in French between 1996 and 2016 was explored through a variety of databases. 19 A total of 654 sources were found and exported to reference manager software (Zotero). Following the elimination of duplicates and non-English or French sources, 633 scientific sources remained (see figure 1 ).…”

“…More precisely, sources were included if the participants were: (1) 65 years old and over, with or without cognitive impairment as documented by screening tests or categorised by the authors of the sources (seniors who were reported ‘independent’ by authors were also categorised as older adults without cognitive impairment), (2) living in the community (house, private residence, senior housing or other structured environments) and (3) presenting to the ED because of an avoidable incident. 19 As incidents occurring in seniors with cognitive impairment were rarely discussed in literature, sources from other hospital settings (eg, hospitalisation) were also included when too few sources focused on ED visits. Furthermore, sources were considered if they focused on strategies and preventive measures to avoid these incidents.…”

“…Data charting was performed independently by two members of the research team (MGR and BH) and/or two collaborators (SS and ACLC) using the data charting form developed according to the study’s objectives. 19 To insure inter-rater agreement, four articles were analysed independently by the first author and each of the reviewers. Descriptive numerical summary analysis and content analysis 21 were also independently performed by two members of the research team (MGR and BH) as described in the protocol.…”

“…Descriptive numerical summary analysis and content analysis 21 were also independently performed by two members of the research team (MGR and BH) as described in the protocol. 19 Results were reported using descriptive statistics and narrative synthesis, according to the main type of avoidable incidents emerging from literature. Finally, results were presented to stakeholders from the Regional Public Health Department in the province of Quebec (Canada) and researchers in gerontology and ED services.…”