This scoping review examines the literature on care transition interventions for patients with cognitive impairment receiving ED care and what measures of quality transitions are important for older
adults with impaired cognition and their care partners
This scoping review demonstrates the state of research on ED care
practices for PLWDs. This review demonstrates that studies of components of ED care and emergency care needs for PLWDs are wide ranging with little depth on any topic.
Communication factors that influence satisfaction with the hospital experience for PLWD included valuing of the person through staff actions, interactions, and person-centered care; activities of empowerment; and interactions of the environment with patient well-being (physical environment, social and organizational). Robust communication between hospital staff, PLWD and their care partners improves the hospital experience.
Over the last 2 decades, there have been multiple studies evaluating ED detection of cognitive impairment specifically focused on
dementia. Our scoping review identified more than 45 manuscripts
addressing accuracy of detection of cognitive impairment or dementia, 66 addressing pragmatic and practical ways for this detection, and
21 manuscripts overlapping in both.
The ED Practices Work Group aims to develop key questions and identify research gaps in optimal care for people living with dementia seeking acute, unscheduled care in the ED or through alternative means, such as telehealth or community paramedicine.
Approximately 40 percent of people living with dementia discharged from the hospital will experience an adverse event (ED revisits, other hospitalizations, or death) in the 30 days following discharge, a rate significantly higher than for those without dementia.
Dementia may add layers of complexity to current ED communication strategies, but this complexity must be addressed to ensure the patient, as well as care partners, feel that they are part of the care process.
Emergency care for older adults is suboptimal, and care is especially poor for older adults with dementia, even though these adults seek ED-based care more regularly than matched controls. The GEAR Detection Work Group examines the potential role of the ED in dementia detection.
People with dementia are twice as likely to use the ED and 1.5 times more likely to have an avoidable visit. When in the ED, they often struggle and are at greater risk of poor outcomes.
A large amount of evidence indicates that an ED visit is a period of vulnerability for older adults, especially as they transition back to the community, from the ED to home or a nursing home.
