Evaluating older adults with cognitive dysfunction: A qualitative study with emergency clinicians

Abstract

Background Evaluating older adults with cognitive dysfunction in emergency departments (EDs) requires obtaining collateral information from sources other than the patient. Understanding the challenges emergency clinicians face in obtaining collateral information can inform development of interventions to improve geriatric emergency care and, more specifically, detection of ED delirium. The objective was to understand emergency clinicians' experiences obtaining collateral information on older adults with cognitive dysfunction, both before and during the COVID‐19 pandemic. Methods From February to May 2021, we conducted semi‐structured interviews with a purposive sample of 22 emergency physicians and advanced practice providers from two urban academic hospitals and one community hospital in the Northeast United States. Interviews lasted 10–20 min and were digitally recorded and transcribed. Interview transcripts were analyzed for dominant themes using a combined deductive–inductive approach. Responses regarding experiences before and during the pandemic were compared. Results Five major challenges emerged regarding (1) availability of caregivers, (2) reliability of sources, (3) language barriers, (4) time constraints, and (5) incomplete transfer documentation. Participants perceived all challenges, but those relating to transfer documentation were amplified by the COVID‐19 pandemic. Conclusion Emergency clinicians' perspectives can inform efforts to support caregiver presence at bedside and develop standardized communication tools to improve recognition of delirium and, more broadly, geriatric emergency care.

Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening

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Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference

“…Although some of the dementia screening, communication, or care transition interventions used personnel or equipment that is not routinely available in the average ED, almost all used time-on-task that is often identified as a barrier to improving the process of care for PLWD. 20 The tension between desirable care noted by GEAR 2.0-ADC for PLWD and their care partners vs the strain of delivering emergency care for all patients with time-critical diagnoses in the ED was palpable in the key stakeholders' discussions and voting to prioritize the research questions. To create interventions with the optimal potential for scale-up via implementation science, future emergency medicine research including PLWD will need to investigate real-world settings with disruptive, pragmatic innovations.…”

Reply to: Expanding options to include language barriers for predicting postoperative delirium in geriatric patients

“…We thank Streetman et al 1 for their insightful commentary on our manuscript about challenges evaluating patients with cognitive dysfunction in emergency departments (EDs). 2 They highlight a finding from our research with important implications for health equity: language barriers between clinicians and patients can confound ED assessment for delirium. Streetman et al draw a parallel in surgical care, highlighting increased risks of postoperative complications among patients whose primary language differs from the language of healthcare delivery.…”