GEAR 2.0 Priorities – ED Practices

The Emergency Department (ED) is an unfamiliar, overstimulating environment for Persons Living With Dementia (PLWD). Emergency clinicians have access to limited information and lack a previous relationship with patients, which can lead to care which is not aligned with the needs of PLWD who are more likely to be hospitalized and have longer hospital lengths of stay. This results in increased risk for delirium, delirium, falls, nosocomial infections, functional decline, and higher healthcare costs. Even for patients who are discharged, ED visits often lead to poor outcomes. PLWD in the ED have higher rates of adverse outcomes including repeat ED visits, delirium, falls, unsafe behaviors, declines in physical function, and mortality compared to older adults without dementia.

In 2013, the Geriatric Emergency Department Guidelines were produced and endorsed by key stakeholder groups including the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the American Geriatrics Society, and the Emergency Nurses Association.  The purpose of these guidelines was to improve care of the geriatric population in a way that is feasible to implement in the ED. Recommended care for PLWD includes:

  • evaluating older adults for cognitive impairment,
  • coordinating their care,
  • limiting the use of chemical and physical restraints to only those situations in which they are absolutely necessary, and
  • maximizing the use of alternate safety measures to manage the agitated geriatric patient.

At the time of these recommendations, research surrounding optimal care practices for PLWD in the ED was lacking.

The goal of the ED Practices Work Group is to develop key questions and identify research gaps in optimal care for PLWD who are seeking acute, unscheduled care in the ED or through alternative means, such as telehealth or community paramedicine.

The ED Practices WG identified two key PICO questions to the literature review.

  • PICO-1: What components of ED care improve patient-centered outcomes for PLWD?
  • PICO-2: How do emergency care needs for PLWD differ from other patients in the ED?

Top Research Priority Areas

The top voted ED practices research priority areas ranked during the 2021 GEAR 2.0 Consensus Conference based on the scoping reviews are as follows: