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. 2026 Jan;33(1):e70074.
doi: 10.1111/acem.70074. Epub 2025 Jun 19.

A systematic review of interventions for persons living with dementia: The Geriatric ED Guidelines 2.0

Sangil Lee  1 , Michelle Suh  2 , Luna Ragsdale  3   4 , Justine Seidenfeld  3   4   5 , James D van Oppen  6 , Lauren Lapointe-Shaw  7 , Carolina Diniz Hooper  8 , James Jaramillo  9 , Annie B Wescott  10 , Alexander X Lo  11 , Kaiho Hirata  12 , Maura Kennedy  13 , Lauren Cameron Comasco  14   15 , Christopher R Carpenter  16 , Teresita M Hogan  17   18 , Shan W Liu  13 ; Geriatric ED Guidelines Dementia Writing Group
Collaborators, Affiliations

A systematic review of interventions for persons living with dementia: The Geriatric ED Guidelines 2.0

Sangil Lee et al. Acad Emerg Med. 2026 Jan.

Abstract

Background: The increasing prevalence of dementia poses significant challenges for emergency department (ED) care, as persons living with dementia (PLWD) more frequently experience adverse outcomes such as delirium, prolonged stays, and higher mortality rates. Despite advancements in care strategies, a critical gap remains in understanding how ED interventions impact outcomes in this vulnerable population. This systematic review aims to identify evidence-based ED care interventions tailored to PLWD to improve outcomes.

Methods: A systematic review was conducted in Ovid MEDLINE, Cochrane Library (Wiley), Scopus (Elsevier), and ProQuest Dissertations & Theses Global through September 2024. The review protocol was registered on PROSPERO (CRD42024586555). Eligible studies included randomized controlled trials, observational studies, and quality improvement initiatives focused on ED interventions for PLWD. Data extraction and quality assessment were performed independently by two reviewers, with disagreements resolved through discussion. Outcomes included patient satisfaction, ED revisits, functional decline, and mortality.

Results: From 3305 screened studies, six met the inclusion criteria. Interventions included nonpharmacologic therapies (e.g., music and light therapy), specialized geriatric ED units, and assessment tools, such as for pain. Tailored interventions including geriatric emergency units and community paramedic care transitions were effective in reducing 30-day ED revisits and hospitalizations. However, heterogeneity in study designs and outcomes precluded meta-analysis. Risk of bias ranged from low to moderate.

Conclusion: This review underscores the urgent need for standardized and evidence-based interventions in ED settings for PLWD. Approaches including multidisciplinary care models and nonpharmacologic therapies demonstrated potential for improving outcomes. Future research should prioritize consistent outcome measures, interdisciplinary collaboration, and person-centered care strategies to enhance the quality and equity of ED services for PLWD.

Keywords: Alzheimer's disease and related dementia; dementia; emergency department; intervention; prevention; systematic review.

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Figures

FIGURE 1
FIGURE 1
Selection of studies (PRISMA).
FIGURE 2
FIGURE 2
Risk of bias (cohort study).
FIGURE 3
FIGURE 3
Risk of bias (RCT parallel and cluster).
See this image and copyright information in PMC

Update of

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