Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;23(8):1314.e1-1314.e29.
doi: 10.1016/j.jamda.2022.05.024.

Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

Scott M Dresden  1 , Zachary Taylor  2 , Peter Serina  2 , Maura Kennedy  3 , Annie B Wescott  4 , Teresita Hogan  5 , Manish N Shah  6 , Ula Hwang  7 ; GEAR 2.0-ADC Network
Collaborators, Affiliations

Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

Scott M Dresden et al. J Am Med Dir Assoc. 2022 Aug.

Abstract

Objectives: To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities.

Design: Systematic scoping review.

Settings and participants: PLWDs in the ED.

Methods: The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities.

Results: From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs.

Conclusions and implications: A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.

Keywords: Emergency department; cognitive impairment; dementia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
PRISMA 2020 flow diagram for new systematic reviews that included searches of databases and registers only.
Fig. 2.
Fig. 2.
Summary model of emergency care practices for persons living with dementia. FAM-CAM, FAMily-Confusion Assessment Method.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010–2050) estimated using the 2010 census. Neurology. 2013;80:1778–1783. - PMC - PubMed
    1. Hunt LJ, Coombs LA, Stephens CE. Emergency department use by community-dwelling individuals with dementia in the United States: an integrative review. J Gerontol Nurs. 2018;44:23–30. - PMC - PubMed
    1. Kent T, Lesser A, Israni J, Hwang U, Carpenter C, Ko KJ. 30-day emergency department revisit rates among older adults with documented dementia. J Am Geriatr Soc. 2019;67:2254–2259. - PMC - PubMed
    1. Hwang U, Morrison RS. The geriatric emergency department. J Am Geriatr Soc. 2007;55:1873–1876. - PubMed
    1. Ostir GV, Schenkel SM, Berges IM, Kostelec T, Pimentel L. Cognitive health and risk of ED revisit in underserved older adults. Am J Emerg Med. 2016;34:1973–1976. - PubMed

Publication types