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

doi:10.1111/acem.70074

. 2025 Jun 19.

doi: 10.1111/acem.70074. Online ahead of print.

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

Sangil Lee¹, Michelle Suh², Luna Ragsdale^{3

4}, Justine Seidenfeld^{3

4

5}, James D van Oppen⁶, Lauren Lapointe-Shaw⁷, Carolina Diniz Hooper⁸, James Jaramillo⁹, Annie B Wescott¹⁰, Alexander X Lo¹¹, Kaiho Hirata¹², Maura Kennedy¹³, Lauren Cameron Comasco^{14

15}, Christopher R Carpenter¹⁶, Teresita M Hogan^{17

18}, Shan W Liu¹³; Geriatric ED Guidelines Dementia Writing Group

Collaborators, Affiliations

Collaborators

Geriatric ED Guidelines Dementia Writing Group:
Scott Dresden, Angel Li, Cameron J Gettel, R Doreen Monks

Affiliations

¹ Department of Emergency Medicine, College of Medicine, University of Iowa Carver, Iowa City, Iowa, USA.
² Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA.
³ Emergency Department, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
⁴ Department of Emergency Medicine, Duke University Hospital, Durham, North Carolina, USA.
⁵ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
⁶ Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, UK.
⁷ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
⁹ Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut, USA.
¹⁰ Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹² Department of Emergency Medicine, International University of Health and Welfare Narita, Chiba, Japan.
¹³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA.
¹⁵ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.
¹⁶ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁷ Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
¹⁸ Section of Geriatrics & Palliative Care, University of Chicago, Chicago, Illinois, USA.

PMID: 40534401
DOI: 10.1111/acem.70074

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

Sangil Lee et al. Acad Emerg Med. 2025.

. 2025 Jun 19.

doi: 10.1111/acem.70074. Online ahead of print.

Authors

Collaborators

Geriatric ED Guidelines Dementia Writing Group:
Scott Dresden, Angel Li, Cameron J Gettel, R Doreen Monks

Affiliations

¹ Department of Emergency Medicine, College of Medicine, University of Iowa Carver, Iowa City, Iowa, USA.
² Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA.
³ Emergency Department, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
⁴ Department of Emergency Medicine, Duke University Hospital, Durham, North Carolina, USA.
⁵ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
⁶ Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, UK.
⁷ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
⁹ Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut, USA.
¹⁰ Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹² Department of Emergency Medicine, International University of Health and Welfare Narita, Chiba, Japan.
¹³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA.
¹⁵ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.
¹⁶ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁷ Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
¹⁸ Section of Geriatrics & Palliative Care, University of Chicago, Chicago, Illinois, USA.

PMID: 40534401
DOI: 10.1111/acem.70074

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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Update of

A Systematic Review of Interventions for Persons Living With Dementia: The Geriatric ED Guidelines 2.0.
Lee S, Suh M, Ragsdale L, Seidenfeld J, van Oppen JD, Lapointe-Shaw L, Hooper CD, Jaramillo J, Wescott AB, Hirata K, Kennedy M, Comasco LC, Carpenter CR, Hogan TM, Liu SW; Geriatric ED Guidelines dementia writing group. Lee S, et al. medRxiv [Preprint]. 2025 Mar 3:2025.02.28.25323113. doi: 10.1101/2025.02.28.25323113. medRxiv. 2025. Update in: Acad Emerg Med. 2025 Jun 19. doi: 10.1111/acem.70074. PMID: 40093231 Free PMC article. Updated. Preprint.

References

REFERENCES

1. Alzheimer's Facts and Figures Report | Alzheimer's Association. Accessed February 27, 2025. https://www.alz.org/alzheimers‐dementia/facts‐figures
1. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019. Lancet Public Health. 2022;7(2):e105‐e125. doi:10.1016/S2468-2667(21)00249-8
1. Daras LC, Feng Z, Wiener JM, Kaganova Y. Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia. Inquiry. 2017;54:46958017696757. doi:10.1177/0046958017696757
1. Zafeiridi E, McMichael A, O'Hara L, Passmore P, McGuinness B. Hospital admissions and emergency department visits for people with dementia. QJM. 2024;117(2):119‐124. doi:10.1093/qjmed/hcad232
1. Green RK, Shah MN, Clark LR, Batt RJ, Chin NA, Patterson BW. Comparing emergency department use among individuals with varying levels of cognitive impairment. BMC Geriatr. 2022;22(1):382. doi:10.1186/s12877-022-03093-5

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[1] Alzheimer's Facts and Figures Report | Alzheimer's Association. Accessed February 27, 2025. https://www.alz.org/alzheimers‐dementia/facts‐figures

[2] Alzheimer's Facts and Figures Report | Alzheimer's Association. Accessed February 27, 2025. https://www.alz.org/alzheimers‐dementia/facts‐figures

[3] GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019. Lancet Public Health. 2022;7(2):e105‐e125. doi:10.1016/S2468-2667(21)00249-8

[4] GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019. Lancet Public Health. 2022;7(2):e105‐e125. doi:10.1016/S2468-2667(21)00249-8

[5] Daras LC, Feng Z, Wiener JM, Kaganova Y. Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia. Inquiry. 2017;54:46958017696757. doi:10.1177/0046958017696757

[6] Daras LC, Feng Z, Wiener JM, Kaganova Y. Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia. Inquiry. 2017;54:46958017696757. doi:10.1177/0046958017696757

[7] Zafeiridi E, McMichael A, O'Hara L, Passmore P, McGuinness B. Hospital admissions and emergency department visits for people with dementia. QJM. 2024;117(2):119‐124. doi:10.1093/qjmed/hcad232

[8] Zafeiridi E, McMichael A, O'Hara L, Passmore P, McGuinness B. Hospital admissions and emergency department visits for people with dementia. QJM. 2024;117(2):119‐124. doi:10.1093/qjmed/hcad232

[9] Green RK, Shah MN, Clark LR, Batt RJ, Chin NA, Patterson BW. Comparing emergency department use among individuals with varying levels of cognitive impairment. BMC Geriatr. 2022;22(1):382. doi:10.1186/s12877-022-03093-5

[10] Green RK, Shah MN, Clark LR, Batt RJ, Chin NA, Patterson BW. Comparing emergency department use among individuals with varying levels of cognitive impairment. BMC Geriatr. 2022;22(1):382. doi:10.1186/s12877-022-03093-5

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

Collaborators

Affiliations

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

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Collaborators

Affiliations

Abstract

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