Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review.
Repository Usage Stats
ObjectivesWe aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.
DesignSystematic scoping review.
Setting and participantsED patients with cognitive impairment and/or their care partners.
MethodsInformed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.
ResultsFrom 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.
Conclusions and implicationsThis scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.
Published Version (Please cite this version)
Gettel, Cameron J, Jason R Falvey, Angela Gifford, Ly Hoang, Leslie A Christensen, Ula Hwang, Manish N Shah, undefined GEAR 2.0-ADC Network, et al. (2022). Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review. Journal of the American Medical Directors Association, 23(8). pp. 1313.e1–1313.e13. 10.1016/j.jamda.2022.01.076 Retrieved from https://hdl.handle.net/10161/27516.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.