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

2022; Elsevier BV; Volume: 23; Issue: 8 Linguagem: Inglês

10.1016/j.jamda.2022.05.024

1538-9375

Scott M. Dresden, Zachary Taylor, Peter Serina, Maura Kennedy, Annie Wescott, Teresita M. Hogan, Manish N. Shah, Ula Hwang, Neelum T. Aggarawal, Heather Allore, Amy Aloysi, Michael Belleville, Fernanda M. Bellolio, Marian E. Betz, Kevin Biese, Cynthia Brandt, Stacey Bruursema, Ryan M. Carnahan, Christopher R. Carpenter, David B. Carr, Jennie Chin‐Hansen, Morgan Daven, Nida Degesys, Scott M. Dresden, Jeffrey Dussetschleger, Michael Ellenbogen, Jason R. Falvey, Beverley Foster, Cameron J. Gettel, Angela Gifford, Andrea Gilmore‐Bykovskyi, Elizabeth M. Goldberg, Jin H. Han, James Hardy, Susan N. Hastings, Jon Mark Hirshon, Ly Hoang, Teresita M. Hogan, William W. Hung, Ula Hwang, Eric Isaacs, Naveena Jaspal, Deb Jobe, Jerry Johnson, Kathleen Kelly, Maura Kennedy, Amy Kind, Jesseca Leggett, Michael Malone, Michelle Moccia, Monica Moreno, Nancy Morrow‐Howell, Armin Nowroozpoor, Ugochi Ohuabunwa, Brenda Oiyemhonian, William Perry, Beth Prusaczyk, Jason Resendez, Kristin L. Rising, Mary Sano, Bob Savage, Manish N. Shah, Joe Suyama, Jeremy Swartzberg, Zachary T. Taylor, Vaishal Tolia, Allan Vann, Teresa Webb, Sandra Weıntraub,

Healthcare Decision-Making and Restraints

ObjectivesTo summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities.DesignSystematic scoping review.Settings and ParticipantsPLWDs in the ED.MethodsThe 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.ResultsFrom 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 ImplicationsA 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.