Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study

Beck, Aaron P; Jacobsohn, Gwen Costa; Hollander, Matthew M.; Gilmore‐Bykovskyi, Andrea; Werner, Nicole E.; Shah, Manish N.

doi:10.1177/1471301220905233

Cited by 5 publications

(5 citation statements)

References 62 publications

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“…By incorporating these additional variables, such as cognitive status, caregiver burden, access to care, and social determinants of health, we can gain a deeper understanding of the factors contributing to recurrent ED visits among PLWD. For instance, work that we have previously done has identified that primary care providers do not have the resources to fully diagnose and treat PLWD, leading to their referral to the ED 4,10 …”

Section: Figurementioning

confidence: 99%

“…For instance, work that we have previously done has identified that primary care providers do not have the resources to fully diagnose and treat PLWD, leading to their referral to the ED. 4,10 Future research must involve PLWD and their care partners as well. Qualitative research can provide insights into patient preferences, social and cultural factors influencing healthcare decisions, and the experiences of PLWD and their care partners as well as providing a deeper understanding of the barriers faced with ED transitions.…”

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confidence: 99%

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Recurrent emergency department visits among persons living with dementia: Bending the curve

Shah,

Hwang

2023

J American Geriatrics Society

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Section: Figurementioning

confidence: 99%

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confidence: 99%

Recurrent emergency department visits among persons living with dementia: Bending the curve

Shah,

Hwang

2023

J American Geriatrics Society

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“…Additionally, it's holistic approach to care can lead to a higher quality of life and improvement in the health and wellbeing of people living with dementia (Spenceley et al 2015), potentially extending time living in the place of their choice. However, with its complex physical, behavioural and psychosocial needs, dementia is poorly recognised, diagnosed and managed within general practice (Beck et al 2021). GP barriers to optimal dementia care include lack of knowledge and skills in the management of this disease and insufficient time to provide support to the person living with dementia and their carer (Heintz et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study

Gibson

Goeman

Yates

et al. 2023

Aust. J. Prim. Health

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Background Worldwide, responsibility for dementia diagnosis and management is shifting to primary care, in particular to the general practitioner (GP). It has been acknowledged that primary care nurses, working collaboratively with GPs, have a role in dementia care by utilising their unique knowledge and skills. However, there are no best-practice guidelines or care pathways to inform nurses in general practice on what best-practice dementia care comprises and how to implement this into their practice. This study identified the recommendations in the Australian guidelines for dementia management most relevant to the role of the nurse working in general practice. Methods Seventeen experts active in clinical practice and/or research in primary care nursing in general practice participated in an online three-round Delphi study. Results All 17 participants were female with a nursing qualification and experienced in general practice clinical nursing and/or general practice nursing research. Five recommendations were identified as the most relevant to the role of the nurse in general practice. These recommendations all contained elements of person-centred care: the delivery of individualised information, ongoing support, including the carer in decision-making, and they also align with the areas where GPs want support in dementia care provision. Conclusion This novel study identified best-practice dementia care recommendations specific to nurses in general practice. These recommendations will inform a model of care for nurses in the provision of dementia care that supports GPs and better meets the needs of people living with dementia and their carer(s).

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“…Caregivers report more emotional [28] and physical stress, more hours per week spent providing care, less time for themselves and other families, and had more work-related problems than caregivers of persons with noncognitive (physical) impairments [29]. In addition, emergency department use is associated with caregiver depression and care recipient functional, behavioral, and psychological symptoms [29,30]. Concerns about the needs of caregivers of persons with cognitive impairment, including dementia, have motivated the development of dementia care management programs [31,32], adult day centers, and community support services for people living with dementia and their caregivers.…”

Section: Introductionmentioning

confidence: 99%

Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial

Chodosh¹,

Connor²,

Fowler³

et al. 2022

JMIR Res Protoc

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Background Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients (POISED) trial, compared with usual care. We described the research design, intervention, outcome measures, data collection techniques, and analysis plans. Methods Emergency department patients who were aged ≥75 years and screened positive for cognitive impairment via either the Mini-Cog or the proxy-reported Short Informant Questionnaire on Cognitive Decline in the Elderly, with a planned discharge to home, were recruited to participate with their identified informal (family or friend) caregiver in the 2-site POISED randomized controlled trial at New York University Langone Health and Indiana University. The intervention group received 6 months of care management from the POISED Care Team of registered nurses and specialty-trained paraprofessionals, who perform root cause analyses, administer standardized assessments, provide advice, recommend appropriate referrals, and, when applicable, implement dementia-specific comorbid condition protocols. The control group received care as recommended at emergency department discharge (usual care) and were given information about resources for further cognitive assessment. The primary outcome is repeat emergency department use; secondary outcomes include caregiver activation for patient health care management, caregiver depression, anxiety, and experience of social support as important predisposing and time-varying enabling and need characteristics. Data were collected from questionnaires and patients’ electronic health records. Results Recruitment was conducted between March 2018 and May 2021. Study findings will be published in peer-reviewed journals and presented to peer audiences, decision makers, stakeholders, and other interested persons. Conclusions The POISED intervention is a promising approach to tailoring care management based on root causes for emergency department admission of patients with cognitive impairment with the aim of reducing readmissions. This trial will provide insights for caregivers and emergency department and primary care providers on appropriate, personalized, and proactive treatment plans for older adults with cognitive impairment. The findings will be relevant to audiences concerned with quality of life for individuals with cognitive impairment and their caregivers. Trial Registration ClinicalTrials.gov NCT03325608; https://clinicaltrials.gov/ct2/show/NCT03325608 International Registered Report Identifier (IRRID) DERR1-10.2196/36607

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Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study

Abstract: Background: Persons with dementia use emergency department services at rates greater than other older adults. Despite risks associated with emergency department use, persons with

Cited by 5 publications

References 62 publications

Recurrent emergency department visits among persons living with dementia: Bending the curve

Recurrent emergency department visits among persons living with dementia: Bending the curve

Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study

Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial

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