Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review

Parke, Belinda; Beaith, Amy; Slater, Linda; Clarke, Antony

doi:10.1111/j.1365-2648.2011.05611.x

Cited by 31 publications

(36 citation statements)

References 84 publications

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“…However, the study excluded patients with clinical needs for specialist services, such as surgery or stroke units. A scoping review of interventions for cognitively impaired older people in emergency departments found no evaluations of organisational or system level interventions and little evidence of appropriate interventions [61]. We found no evaluations of interventions aimed specifically at our three target comorbidities, although a retrospective analysis of stroke patients suggested that cognitively impaired patients benefit from admission to an acute rehabilitation stroke unit [63].…”

Section: Models Of Care For Older People With Cognitive Impairmentmentioning

confidence: 82%

Comorbidity and dementia: a scoping review of the literature

et al. 2014

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Background: Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. Methods: We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014).

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Section: Models Of Care For Older People With Cognitive Impairmentmentioning

confidence: 82%

Comorbidity and dementia: a scoping review of the literature

et al. 2014

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“…124 We found no evaluations of interventions aimed specifically at our three target comorbidities, although a retrospective analysis of stroke patients suggested that cognitively impaired patients benefit from admission to an acute rehabilitation stroke unit. 126 …”

Section: Results Of the Scoping Reviewmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Best practice potentials for the care of this vulnerable population in the ED setting, some of which having been proposed by other authors, 3,12,32 are presented in Box 1. In ED, there was geriatric input in one patient only, while a geriatric assessment team would have accepted care of 108 patients who were subsequently admitted to the acute care setting.…”

Section: Improving Patient Care and Outcomesmentioning

confidence: 99%

“…[11][12][13] Several recommendations, targeting ED's physical layout, modifications of care delivery, and staff education, have been reported to improve the ED experience and outcomes of seniors with CI and their families. 3,11,14 Establishing or refining specific ED services and robust care delivery protocols relevant to the clinical care of this at-risk ED population first requires a good understanding of their presenting features and needs.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study

Schnitker

Beattie

Martin‐Khan

et al. 2016

Australasian Emergency Nursing Journal

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SummaryObjective: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). Methods: This was a multi-centre (n = 8) observational study of a convenience sample of older (≥70 y) ED patients (n = 579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n = 191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. Results: Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semiurgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6 h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), * Corresponding author at: School of Nursing, Queensland University of Technology, Brisbane, Australia.

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Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review

Cited by 31 publications

References 84 publications

Comorbidity and dementia: a scoping review of the literature

Comorbidity and dementia: a scoping review of the literature

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study

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