The Geriatric-Focused Emergency Department: Opportunities and Challenges

Sloane, Philip D.

doi:10.1016/j.jamda.2022.06.017

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…46 Both practices, along with better coordination with community care, would improve the ED-to-community transition, the success which may be a key factor in preventing return to the ED. Patients may also benefit from attending geriatric EDs, which must meet staffing, educational, and physical environment standards designed to optimize ED care for older adults 47,48 Finally, our finding on the high use of antipsychotics, anticonvulsants, and benzodiazepines supports the implementation of collaborative medication review in the ED. Medication reviews with pharmacist and/or geriatrician involvement can improve medication appropriateness measures, 49 though benefits to future health service use are unclear.…”

Section: <5 ≥5mentioning

confidence: 65%

Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study

Jones

Watt

Maclagan

et al. 2023

J American Geriatrics Society

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BackgroundResearch on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits.MethodsWe used health administrative databases to conduct a population‐based retrospective cohort study among older adults with dementia in Ontario, Canada. We included community‐dwelling adults 66 years and older who visited the ED between April 1, 2010, and March 31, 2019 and were discharged home. We recorded all ED visits within one year after the baseline visit. We used recurrent event Cox regression to examine associations between repeat ED visits and individual clinical, demographic, and health service use characteristics. We fit conditional inference trees to identify the most important factors and define subgroups of varying risk.ResultsOur cohort included 175,863 older adults with dementia. ED use in the year prior to baseline had the strongest association with recurrent visits (3+ vs.0 adjusted hazard ratio (aHR): 1.92 (1.89, 1.94), 2vs.0 aHR: 1.45 (1.43, 1.47), 1vs.0 aHR: 1.23 (1.21, 1.24)). The conditional inference tree utilized history of ED visits and comorbidity count to define 12 subgroups with ED revisit rates ranging from 0.79 to 7.27 per year. Older adults in higher risk groups were more likely to live in rural and low‐income areas and had higher use of anticonvulsants, antipsychotics, and benzodiazepines.ConclusionsHistory of ED visits may be a useful measure to identify older adults with dementia who would benefit from additional interventions and supports. A substantial proportion of older adults with dementia have a pattern of recurrent visits and may benefit from dementia‐friendly and geriatric‐focused EDs. Collaborative medication review in the ED and closer follow‐up and engagement with community supports could improve patient care and experience.

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Section: <5 ≥5mentioning

confidence: 65%

Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study

Jones

Watt

Maclagan

et al. 2023

J American Geriatrics Society

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“…Other helpful supports include modifications to clothing, set-ups, equipment, tasks, controls, and environments [4,14,20,31,[58][59][60] to improve access, safety, and function. A good source of these interaction strategies and adaptations are occupational therapists (OT) [57,61], gerontologists (non-physician specialists in older adults), and other care workers from community-based organizations who are trained in dementia support and care strategies [21].…”

Section: Interaction Strategiesmentioning

confidence: 99%

“…Because of the global shortage of neurologists, geriatricians, geriatric psychiatrists and other brain health specialists-ideally routine dementia care will become part of standard primary care, analogous to the current standard of care for congestive heart failure [15,19,40], with PCPs/GPs diagnosing and managing straightforward cases, while specialists are consulted and co-managing complex cases. PLWDs' access to medical care can be further expanded with appropriately trained nurse practitioners, physician assistants, transdisci-plinary hybrid care teams [14,60,101], and Virtual Brain Health Clinics (as described under Fig. 5, Section #2 above).…”

Section: #4 Disclose Diagnosis Refer To Other Services and Plan Follo...mentioning

confidence: 99%

“…This section of the Ideal Care Map also summarizes the best practices of Geriatric-Friendly Emergency Departments [53,58,59,83,[106][107][108] and Acute Care For Elders (ACE) inpatient model of care for hospitalized older adults [109,110]. These involve health systems infrastructure and protocols for addressing a wide range of factors that impact the health outcomes of older adults [4,21,31,45,60,106,111].…”

Section: #5b Assess If Plwd Need Other Levels Of Carementioning

confidence: 99%

“…Training should go beyond an overview of common dementia types. Ideally, all individuals in relevant groups should be trained in communication and interaction skills, how to honor personal preferences, cultural competency, empathy, and not be dismissive of PLWDs' or care partners' concerns [4,5,15,19,20,27,31,35,51,57,60,80,83]. For example, Dementia Friendly Communities is an approach that trains local businesses, grocery stores, restaurants, banks, legal providers, faith communities, healthcare and social services, libraries, airports and other transportation, local governments, and the general public to recognize and support PLWD [5,15,[41][42][43][44][45][46]120].…”

Section: Training Continuing Education and Workforce Supportmentioning

confidence: 99%

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Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community

Dombrowski,

Mims,

Kremer

et al. 2024

JAD

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Background: Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer’s disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. Objective: To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. Methods: A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. Results: The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Conclusions: Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.

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Impact of a geriatric intervention based on the Comprehensive Geriatrics Assessment on avoidable admissions in older patients at risk evaluated in the Emergency Department

Fernández-Montalbán,

Martínez-Flores,

Mir-Montero

et al. 2024

Revista Española de Geriatría y Gerontología

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The Geriatric-Focused Emergency Department: Opportunities and Challenges

Cited by 4 publications

References 31 publications

Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study

Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study

Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community

Impact of a geriatric intervention based on the Comprehensive Geriatrics Assessment on avoidable admissions in older patients at risk evaluated in the Emergency Department

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