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

Abstract

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.

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

“…In our study, community support was central to people with dementia remaining well at home; however, participants described being largely uninformed while navigating a poorly integrated system. This is supported in previous literature, where community support is known to influence urgent care use, 7 with access impeded by limited awareness and service fragmentation 2,21 . Our analyses explore this further, showing that people affected by dementia encounter additional barriers to accessing community health and social care.…”

“…Compared to people without dementia, those with dementia are at increased odds of attending the ED for conditions that are potentially manageable in the community 6 . Limited availability and access to community support contributes to urgent care use among people with dementia 7 . Qualitative literature suggests that ED attendance among people with dementia is influenced by unmet needs at the individual and system level 2 .…”

Patient, carer and healthcare professional experiences of complex care quality in multidisciplinary primary healthcare centres: qualitative study with face-to-face, in-depth interviews and focus groups in five French multidisciplinary primary healthcare centres

“…The present study reveals information about their role in helping patients remain autonomous which supports concepts highlighted in recent scoping reviews. [35][36][37][38] In complex care situations, carers are essential. They not only need to support and care for the patient, who is dependent on them, but also continue their normal social, family, and professional life.…”

Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study

“…The predictive factors of ED utilization among people with dementia have been widely studied [ 6 , 9 , 10 , 12 , 13 ]. It is not surprising that living in NH was one of the significant independent factors of ED visits among people with dementia [ 9 ] because those living in NH were older, with more comorbidities, and with more functional impairment than those not living in NH [ 6 ].…”