Care for older adults living with dementia in the emergency department: a systematic review and meta-synthesis of care partner roles and perspectives

Emergency Medicine Journal, Journal Year: 2025, Volume and Issue: 42(3), P. 154 - 163

Published: Jan. 9, 2025

Care partners play a vital role in supporting persons living with dementia (PLWD) using medical services. We conducted meta-synthesis to explore care partner perspectives of ED for PLWD, as well healthcare provider (HCP) perceptions roles within the ED, identify gaps and facilitators across continuum. MEDLINE, PsycINFO Embase databases were searched from inception 8 May 2023. Grey literature was also searched. Articles included if they reported on or experiences regarding delivery PLWD either perspective HCPs. A charting exercise used categorise primary focus outcomes articles selected inclusion. second derive overarching themes based surrounding barriers care. 16 included. Important identified organised according timepoint visit (pre-ED, during post-ED). Key included: access planning, environment organisational processes, deficits communication patient care, lack involvement clinical decisions, difficulties discharge transitions follow-up information provided by partners, coordination, support engagement. These findings can aid developing dementia-friendly EDs informing policy practices, environmental modifications. Future studies should feasibility effectiveness interventions targeted towards settings. Engagement these intervention will be critical their success.

Language: Английский

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Barriers and facilitators to caring for patients living with dementia in the emergency department: a qualitative study

Canadian Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 13, 2025

Language: Английский

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Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(5), P. 1508 - 1524

Published: Jan. 19, 2024

Multiple short delirium detection tools have been validated in research studies and implemented routine care, but there has little study of these real-world conditions. This systematic review synthesized literature reporting completion rates and/or positive score large clinical populations general hospital settings.

Language: Английский

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A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(11), P. 3551 - 3566

Published: July 12, 2024

The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research.

Language: Английский

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Emergency department communication with diverse caregivers and persons living with dementia: A qualitative study

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(6), P. 1687 - 1696

Published: March 29, 2024

Abstract Background Research to date has detailed numerous challenges in emergency department (ED) communication with persons living dementia (PLWD) and their caregivers. However, little is known about experiences of individuals belonging minoritized racial ethnic groups, who are disproportionately impacted by less likely be included research. Methods We conducted semi‐structured interviews 29 caregivers PLWD from two urban academic hospital EDs distinct patient populations. The first site an ED the Northeast serving a majority White, English‐speaking, insured population. second South Black and/or Hispanic, Spanish‐speaking, underinsured Interviews lasted average 25 min were digitally recorded transcribed. used inductive approach analyze interview transcripts for dominant themes compared between sites. Results Our sample diverse backgrounds. Caregivers cared spoke English, Spanish, Arabic, Chinese, Vietnamese. identified three themes. First, caregiver advocacy was central communication, particularly when primarily non‐English language. Second, routine care plans did not address what mattered most participants PLWD. Participants felt that arose protocols them. Third, White English‐speaking Site 1 more commonly expected staff engage them decision‐making than Black, Asian, Middle Eastern 2. Conclusion Language barriers amplify higher intensity needed ED. Strategies should developed communicating matters care.

Language: Английский

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Decision-Making Process of Homecare Professionals Using Telemonitoring of Activities of Daily Living for Risk Assessment in the SAPA Project: An Embedded Mixed-Methods Multiple-Case Study (Preprint)

Journal of Medical Internet Research, Journal Year: 2025, Volume and Issue: 27, P. e64713 - e64713

Published: Jan. 30, 2025

Background Older adults with cognitive deficits face difficulties in recalling daily challenges and lack self-awareness, impeding home care clinicians from obtaining reliable information on functional decline needs possibly resulting suboptimal service delivery. Activity of living (ADL) telemonitoring has emerged as a tool to optimize evaluation ADL needs. Using ambient sensors, gathers about behaviors such preparing meals sleeping. However, there is significant gap understanding how data can be integrated into clinical reasoning better target services. Objective This paper aims describe (1) are used by maintain recipients at (2) the impact Methods We an embedded mixed methods multiple-case study design examine 3 health institutions located greater Montreal region Quebec that offer public An system—Innovative Easy Assistance System–Support for Adults’ Autonomy (Soutien à l’autonomie des personnes âgées French)—was deployed within these 4 years. Subcases (care recipient, informal caregiver, clinicians) were each case. For this paper, we collected during interviews (45-60 min) only. Quantitative metadata also provided before after implementation NEARS-SAPA triangulate qualitative data. Results analyzed 27 subcases comprising 29 who completed 57 postimplementation concerning 147 reports. Data analysis showed 4-step decision-making process clinicians: extraction relevant data, comparison other sources information, (3) risk assessment recipient’s performance ability remain home, (4) maintenance or modification intervention plan. reporting number services received allowed triangulation pertaining step 4. Overall, results suggest stabilization monthly introduction system, particularly cases where increasing its implementation. consistent indicating that, light most decided current plan rather than increase reduce Conclusions contributed optimization case-by-case basis. may have important role reassuring their management appropriateness delivery, especially when questions regarding relevance Future studies further explore benefits systems larger-scale studies. International Registered Report Identifier (IRRID) RR2-10.2196/52284

Language: Английский

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Outcomes of Older Adults With Delirium Discharged From the Emergency Department

Annals of Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

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Delirium detection in the emergency department: A diagnostic accuracy meta‐analysis of history, physical examination, laboratory tests, and screening instruments

Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: 31(10), P. 1014 - 1036

Published: May 16, 2024

Abstract Introduction Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews history, physical examination, laboratory testing, and ED screening instruments for the diagnosis delirium as well test–treatment thresholds screening. Methods We conducted a review to quantify approaches identify Studies were included if they described adults aged 60 or older evaluated in setting with an index test compared acceptable criterion standard Data extracted studies reviewed risk bias. When appropriate, we meta‐analysis estimated thresholds. Results Full‐text was performed on 55 27 current analysis. No identified exploring findings history While two reported clinicians accurately rule delirium, clinician gestalt is inadequate out report three that quantified 4 A's Test (4AT) (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7–20.7) negative [LR−] 0.18, CI 0.09–0.34) also Abbreviated Mental Test‐4 (AMT‐4) found pooled LR+ (4.3, 2.4–7.8) lower than observed 4AT, but LR− (0.22, 0.05–1) similar. Based one study Confusion Assessment Method Intensive Care Unit (CAM‐ICU) superior instrument The calculated threshold 2% treatment 11%. Conclusions quantitative examination virtually unexplored. 4AT has largest quantity ED‐based research. Other may more If goal then CAM‐ICU brief CAM modified are instruments, although these tools based single‐center studies. To Delirium Triage Screen study.

Language: Английский

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Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference

Journal of the American Medical Directors Association, Journal Year: 2022, Volume and Issue: 23(8), P. 1286 - 1287

Published: Aug. 1, 2022

Language: Английский

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Emergency department utilization and presenting chief complaints by Veterans living with dementia

Academic Emergency Medicine, Journal Year: 2023, Volume and Issue: 30(4), P. 331 - 339

Published: Feb. 9, 2023

Veteran persons living with dementia (PLWDs) have high acute care utilization. We aim to understand why PLWDs seek in the emergency department (ED) and how their utilization differs from older Veterans no diagnosis. demonstrate use of a novel national chief complaint data set Affairs Health Care System.This was retrospective observational study ED users 65 years or as FY2017. The primary outcome is presence one more visits FYs 2017-2018 using logistic regression model controlling for other variables. Secondary outcomes include counts by disposition, Emergency Severity Index, complaints defined natural language processing program, encounter diagnoses International Statistical Classification Diseases, Tenth Revision (ICD-10-CM) code.Our cohort comprised 3,115,263 patients. Of those, 255,372 (8.2%) had diagnosis dementia. Logistic modeling demonstrated that significant predictor (p < 0.0001), likely an visit (odds ratio 1.96, 95% confidence interval 1.94-1.98). were admitted at higher rates when accounting age acuity. Chief common among included falls (6.7% vs. 3.3% without dementia), weakness (3.6% 2.2%), abnormal mental state (2.2% 0.4%). ICD-10-CM codes largely similar between two groups.Our results reinforce access point These patients require special consideration they are be admitted. Our suggests commonly present certain geriatric syndromes nonspecific complaints. Further work needed determine whether these would warrant targeted interventions improve quality care.

Language: Английский

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