Emergency care for people with dementia

Andrews, June; Christie, J E

doi:10.7748/en2009.09.17.5.12.c7250

Cited by 10 publications

(13 citation statements)

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“…As patients and caregivers may lack knowledge of what services are available and how to access them [105], navigating the transition from inpatient to community based care requires intensive effort and coordination to put management plans and caregiver support in place. The importance of supporting transitions is especially underscored in advanced dementia where, unless a care plan is in place, health professionals in acute care may lack awareness that a palliative approach is appropriate and initiate treatments inappropriately aimed at prolonging life with negative effects on quality of life [106,107]. Transitional care between paediatric and adult palliative care services is also a focal point requiring intensive support [57].…”

Section: Resultsmentioning

confidence: 99%

Elements of effective palliative care models: a rapid review

Luckett

Phillips

Agar

et al. 2014

BMC Health Serv Res

160

139

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BackgroundPopulation ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.MethodA rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006).ResultsOf 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals’ changing needs and preferences over time.ConclusionModels of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia’s health system.

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Section: Resultsmentioning

confidence: 99%

Elements of effective palliative care models: a rapid review

Luckett

Phillips

Agar

et al. 2014

BMC Health Serv Res

160

139

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“…); the use of strategies such as dementia care mapping (Brooker ); practice‐based education and role modelling (Feldt & Ryden , Burgess & Page ) and the inclusion in training programmes of content related to communication strategies, management of disturbing behaviours, focusing on resident/patient abilities, caregiver involvement, patient safety, advocacy, pain management and ethics (Wells et al . , Cunningham & McWilliam , Douglas‐Dunbar & Gardiner , Andrews & Christie , James & Hodnett ). However, the evidence base for these features is mostly weak.…”

Section: Resultsmentioning

confidence: 99%

“…One systematic review addressed screening, diagnosis and assessment in A&E but found no empirical studies. The use of standard cognitive screening by emergency nurses as a strategy for recognising dementia in the Emergency Department is recommended (Andrews & Christie 2009), as is assessment of delirium (Cunningham & McWilliam 2006). One review identified a tool recommended for nurse administration (Hare et al 2008).…”

Section: Screening and Diagnosismentioning

confidence: 99%

“…As noted earlier, training in dementia care is required for most staff in general hospitalsfrom basic awareness training through to more comprehensive training for staff delivering direct care to people with dementia. Relevant features of educational interventions described in the literature include designing an educational plan based on assessment of a team's educational needs (Iliffe et al 2012); the use of strategies such as dementia care mapping (Brooker 2005); practice-based education and role modelling (Feldt & Ryden 1992, Burgess & Page 2003 and the inclusion in training programmes of content related to communication strategies, management of disturbing behaviours, focusing on resident/patient abilities, caregiver involvement, patient safety, advocacy, pain management and ethics (Wells et al 2000, Cunningham & McWilliam 2006, Douglas-Dunbar & Gardiner 2007, Andrews & Christie 2009, James & Hodnett 2009). However, the evidence base for these features is mostly weak.…”

Section: Developing the Skills Of Nonspecialist Staffmentioning

confidence: 99%

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The role of the dementia specialist nurse in acute care: a scoping review

Griffiths

Bridges

Sheldon

et al. 2014

Journal of Clinical Nursing

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“…Three of the seven publications address assessment; two recommend use of standard cognitive screening as a strategy for recognizing dementia in the ED, and one includes assessment of delirium . One article asserts that “incorporating assessment of cognitive functioning in the ED should be part of the skill set of any emergency physician.” It notes that ED physicians’ lack of recognition of dementia may result in “poor quality of care measured by delayed and missed diagnoses and increased morbidity” and suggests the addition of three questions: Who brought the patient?…”

Section: Resultsmentioning

confidence: 99%

Clinical Care of Persons with Dementia in the Emergency Department: A Review of the Literature and Agenda for Research

Clevenger

Chu

Zhou

et al. 2012

J American Geriatrics Society

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The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care.

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Emergency care for people with dementia

Cited by 10 publications

References 0 publications

Elements of effective palliative care models: a rapid review

Elements of effective palliative care models: a rapid review

The role of the dementia specialist nurse in acute care: a scoping review

Clinical Care of Persons with Dementia in the Emergency Department: A Review of the Literature and Agenda for Research

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