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Munsterman E, Perez A, Hodgson N, Cacchione P. Dementia friendly in the context of hospitalization: A concept analysis using the Walker & Avant Method. J Adv Nurs 2024. [PMID: 38433345 DOI: 10.1111/jan.16133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/06/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
AIM(S) To evaluate the literature to inform and propose a conceptual definition for dementia friendly in the context of hospitalization. METHODS The Walker & Avant method for concept analysis was utilized for this review. DATA SOURCES (INCLUDE SEARCH DATES) Initial search conducted June 2022. Repeated search conducted in February 2023. Databases for the literature search include Scopus, PubMed, CINAHL, PsycINFO, and AGELINE. RESULTS Five attributes of the concept of dementia friendly in the context of hospitalization were identified including: staff knowledge/education, environmental modification, person-centred care, nursing care delivery and inclusion of family caregivers. Based on these attributes a conceptual definition is proposed. CONCLUSION A clarified definition for dementia friendly in the context of hospitalization will aid in understanding the concept, provide guidance for hospitals seeking to implement dementia-friendly interventions and benefit researchers aiming to study the impact of such programs. REPORTING METHOD: n/a. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
| | - Adriana Perez
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Dresden SM. Optimizing the Care of Persons Living with Dementia in the Emergency Department. Clin Geriatr Med 2023; 39:599-617. [PMID: 37798067 DOI: 10.1016/j.cger.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the specific needs of PLWD, effective communication with PLWD, their care partners, and outpatient clinicians who the patient and care-partner know and trust, and care-transitions from the emergency department to other health care settings. The recommendations in this article made based on wide-ranging heterogeneous studies of various interventions which have been studied primarily in single-site studies. Future research should work to incorporate promising findings from interventions such as hospital at home, or ED to home Care Transitions Intervention.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Center for Healthcare Studies and Outcomes Research, 211 East Ontario Street, Suite 200, Chicago, IL 60611, USA.
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3
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Goodwin L, Liddiard C, Manning S, Benger JR, Carlton E, Cheston R, Hoskins R, Taylor H, Voss S. How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study. BMJ Open 2023; 13:e075022. [PMID: 37541746 PMCID: PMC10407375 DOI: 10.1136/bmjopen-2023-075022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as 'actions that detract from the well-being of individuals due to the physical or psychological distress they cause within the settings they are performed', and can take many forms including aggressive physical actions, shouting and verbal aggression and non-aggressive behaviour including repetitive questioning, inappropriate exposure and resistance to care. DESIGN Mixed-methods study consisting of an online survey and semistructured telephone interviews. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were analysed thematically. SETTING The EDs of three National Health Service (NHS) Hospital Trusts in Southwest England. PARTICIPANTS Multidisciplinary NHS staff working in the ED. RESULTS Fifty-two online survey responses and 13 telephone interviews were analysed. Most (24/36, 67%) survey respondents reported that they had received general training in relation to dementia in the last 2-5 years, however, less than a fifth (4/23, 17%) had received any ED-specific dementia training. All (48/48) felt that behaviour that challenges could potentially be prevented, though resource constraints and practice variation were identified. Four main themes emerged from the qualitative data: (1) the 'perfect storm' of the ED; (2) behaviour that challenges is preventable with the right resources; (3) improvisation and (4) requirement for approaches that are specific to the ED. CONCLUSIONS The findings of this study suggest that ED staff do not feel that they are prepared to respond effectively to behaviour that challenges displayed by people living with dementia. Future work could adapt or develop an intervention to support ED staff in responding to behaviour that challenges.
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Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Cathy Liddiard
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Sera Manning
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Cheston
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rebecca Hoskins
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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4
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Gisch UA, Ahlers E, Lee D, Heuser-Collier I, Somasundaram R. A program for volunteers accompanying older patients with cognitive dysfunction to improve the quality of emergency department care: A pilot study. Geriatr Nurs 2022; 48:94-102. [PMID: 36155315 DOI: 10.1016/j.gerinurse.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022]
Abstract
Admission to an emergency department (ED) is challenging for older patients with cognitive dysfunction (PWCD). Targeted patient-oriented approaches to improve the care for PWCD are needed. The aim of this pilot study was to design and evaluate a program for volunteers to support PWCD in the ED. Volunteers (N = 9) first received a training and during the following six months (N = 90 shifts), they accompanied PWCD (N = 112) during their stay. Results showed that the training increased volunteers' knowledge and expertise, but not shift-related self-efficacy. The most frequent strategies applied were conversations, holding hands and touching, and providing food and drinks. After six months, volunteers reported a great sense of meaningfulness and felt that they were highly appreciated by the patients. ED nurses' sceptical attitudes towards the program decreased. The program is beneficial for PWCD, appears to be meaningful for volunteers and is appreciated by ED nurses.
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Affiliation(s)
- Ulrike A Gisch
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Eike Ahlers
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Johanniter-Krankenhaus Treuenbrietzen, Department of Psychiatry and Psychotherapy, Johanniterstraße 1, 14929 Treuenbrietzen, Germany.
| | - Denise Lee
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Isabella Heuser-Collier
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Rajan Somasundaram
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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5
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Dresden SM, Taylor Z, Serina P, Kennedy M, Wescott AB, Hogan T, Shah MN, Hwang U. Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review. J Am Med Dir Assoc 2022; 23:1314.e1-1314.e29. [PMID: 35940683 DOI: 10.1016/j.jamda.2022.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWDs in the ED. METHODS The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities. RESULTS From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs. CONCLUSIONS AND IMPLICATIONS A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Zachary Taylor
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter Serina
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Annie B Wescott
- Galter Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Teresita Hogan
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
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6
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Clark E, Wood F, Wood S. Barriers and facilitators to the use of personal information documents in health and social care settings for people living with dementia: A thematic synthesis and mapping to the COM-B framework. Health Expect 2022; 25:1215-1231. [PMID: 35415955 PMCID: PMC9327869 DOI: 10.1111/hex.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person-centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation-Behaviour (COM-B) model can be used to understand factors determining individuals' behaviours. OBJECTIVES This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology. METHODS A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high-income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM-B framework. RESULTS Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM-B domain. CONCLUSION This framework provides a starting point for evidence-informed initiatives to improve the use of personal information documents in the care of people with dementia. PATIENT AND PUBLIC CONTRIBUTION This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders).
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Affiliation(s)
- Emily Clark
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
- Cardiff and Vale Local Public Health TeamPublic Health WalesCardiffUK
| | - Fiona Wood
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Suzanne Wood
- Cardiff and Vale Local Public Health TeamPublic Health WalesCardiffUK
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7
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van Oppen JD, Valderas JM, Mackintosh NJ, Conroy SP. Patient-reported outcome and experience measures in geriatric emergency medicine. Z Gerontol Geriatr 2020; 54:122-124. [PMID: 32939573 DOI: 10.1007/s00391-020-01777-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Older people with frailty and health crises have complex physical and social needs. Modern emergency care systems are fast-flowing, using protocols optimised for single-problem presentations. Systems must incorporate individualised care to best serve people with multiple problems. Healthcare quality is typically appraised with service metrics, such as department length of stay and mortality. Worldwide, patient-reported outcome measures (PROM) and patient-reported experience measures (PREM) are increasingly used in research, service development and performance evaluation, paving the ground for their use to support individual clinical decision-making. The PROMs and PREMs are person-centred metrics, which inform healthcare decisions at the individual level and which at the strategic level drive improvement through comparison of interprovider effectiveness. To date, there is no PROM or PREM specifically developed for older people with frailty and emergency care needs.
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Affiliation(s)
- James D van Oppen
- Department of Health Sciences, University of Leicester, LE1 7RH, Leicester, UK. .,Emergency and Specialist Medicine, University Hospitals Leicester NHS Trust, LE1 5WW, Leicester, UK.
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, EX1 2LU, Exeter, UK
| | - Nicola J Mackintosh
- Department of Health Sciences, University of Leicester, LE1 7RH, Leicester, UK
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, LE1 7RH, Leicester, UK.,Emergency and Specialist Medicine, University Hospitals Leicester NHS Trust, LE1 5WW, Leicester, UK
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8
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Watkins S, Murphy F, Kennedy C, Graham M, Dewar B. Caring for older people with dementia in the emergency department. ACTA ACUST UNITED AC 2020; 29:692-699. [PMID: 32579444 DOI: 10.12968/bjon.2020.29.12.692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice. METHODS Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria. RESULTS Three themes were identified: carers and older people with dementia-waiting and worrying; nurses juggling priorities; and strategies for improvement-taking a partnership approach. CONCLUSION Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed.
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Affiliation(s)
- Sarah Watkins
- Advanced Nurse Practitioner (Acute Medicine) Candidate and PhD Candidate, Emergency Department, University Hospital Limerick, Ireland
| | - Fiona Murphy
- Professor of Clinical Nursing, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Catriona Kennedy
- Professor of Community Nursing, School of Nursing and Midwifery, Robert Gordon University, Aberdeen
| | - Margaret Graham
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Belinda Dewar
- Professor of Practice Improvement, School of Health and Life Sciences, University of the West of Scotland, Hamilton, South Lanarkshire
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9
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Beck AP, Jacobsohn GC, Hollander M, Gilmore-Bykovskyi A, Werner N, Shah MN. Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study. DEMENTIA 2020; 20:613-632. [PMID: 32050779 DOI: 10.1177/1471301220905233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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 dementia and their caregivers often seek emergency services to address needs and symptoms that could be managed within primary care settings. As emergency departments (EDs) are typically sub-optimal environments for addressing dementia-related health issues, facilitating effective primary care provision is critical to reduce the need for, or decision to seek, emergency services. The aim of this study is to explore how features of primary care practice influence care-seeking decisions by community-dwelling persons with dementia and familial caregivers. METHODS Semi-structured qualitative interviews were conducted with 27 key dementia-care stakeholders (10 primary care/geriatrics providers, 5 caregivers, 4 emergency medicine physicians, 5 aging service providers, and 3 community paramedics) from multiple health systems. Transcripts from audio recordings were analyzed using a thematic analysis framework to iteratively code and develop emergent themes. Features of primary care were also synthesized into lists of tangible factors leading to emergency care-seeking and those that help prevent (or decrease the need for) ED use. FINDINGS Stakeholders identified eight categories of features of primary care encompassing the clinical environment and provision of care. These collapsed into four major themes: (1) clinic and organizational features-including clinic structure and care team staffing; (2) emphasizing proactive approaches to anticipate needs and avoid acute problems-including establishing goals of care, preparing for the future, developing provider-patient/provider-caregiver relationships, and providing caregiver support, education, and resources to help prevent emergencies; (3) health care provider skills and knowledge of dementia-including training and diagnostic capabilities; and (4) engaging appropriate community services/resources to address evolving needs. CONCLUSIONS Features of primary care practice influence decisions to seek emergency department care at the system, organizational/clinic, medical, and interpersonal levels, particularly regarding proactive and reactive approaches to addressing dementia-related needs. Interventions for improving primary care for persons with dementia and their caregivers should consider incorporating features that facilitate proactive family-centered dementia care across the four identified themes, and minimize those leading to caregiver decisions to utilize emergency services.
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Affiliation(s)
| | | | - Matthew Hollander
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Nicole Werner
- College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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10
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Leggett A, Connell C, Dubin L, Dunkle R, Langa KM, Maust DT, Roberts JS, Spencer B, Kales HC. Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change. J Am Med Dir Assoc 2019; 20:1307-1312.e1. [PMID: 31147289 PMCID: PMC6768732 DOI: 10.1016/j.jamda.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change. DESIGN Aimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016. SETTING AND PARTICIPANTS Forty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system. MEASURES Qualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care. RESULTS Key themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge. CONCLUSIONS AND IMPLICATIONS Five key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.
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Affiliation(s)
- Amanda Leggett
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI.
| | - Cathleen Connell
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Leslie Dubin
- School of Social Work, University of Michigan, Ann Arbor, MI; Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ruth Dunkle
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research, Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Donovan T Maust
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - J Scott Roberts
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Beth Spencer
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Helen C Kales
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI
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11
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Cetin-Sahin D, Ducharme F, McCusker J, Veillette N, Cossette S, Vu TTM, Vadeboncoeur A, Lachance PA, Mah R, Berthelot S. Experiences of an Emergency Department Visit Among Older Adults and Their Families: Qualitative Findings From a Mixed-Methods Study. J Patient Exp 2019; 7:346-356. [PMID: 32821794 PMCID: PMC7410141 DOI: 10.1177/2374373519837238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective To explore experiences of an ED visit among patients aged 75 and older. Methods In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.
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Affiliation(s)
- Deniz Cetin-Sahin
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada.,Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Quebec, Canada
| | - Francine Ducharme
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Jane McCusker
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Nathalie Veillette
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Sylvie Cossette
- University of Montreal, Montreal, Quebec, Canada.,Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - T T Minh Vu
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Centre hospitalier de l'université de Montréal, Montreal, Quebec, Canada
| | - Alain Vadeboncoeur
- University of Montreal, Montreal, Quebec, Canada.,Emergency Medicine Services, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul-André Lachance
- University of Montreal, Montreal, Quebec, Canada.,Hôpital de la Cité-de-la-Santé, Laval, Quebec, Canada
| | - Rick Mah
- St. Mary's Hospital Center, Montreal, Quebec, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Canada
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12
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Watkins S, Murphy F, Kennedy C, Dewar B, Graham M. Caring for an older person with dementia in the Emergency Department (ED): An Appreciative Inquiry exploring family member and ED nurse experiences. J Clin Nurs 2019; 28:2801-2812. [PMID: 30946498 DOI: 10.1111/jocn.14854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/11/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To generate insights about what matters and is valued by family members of older people with dementia in the emergency department. To explore the experiences of emergency nurses looking after older people with dementia in an episode of care. BACKGROUND In the emergency department, older people with dementia are at risk of suboptimal care. Little is known of the experiences of family members of being with an older person with dementia in the emergency department or the experiences of emergency nurses looking after older people with dementia in this environment. DESIGN AND METHODS Phase 1 Data Analysis of the Discovery Phase of an Appreciative Inquiry study. Study participants were family members of older people with dementia and emergency nurses. Data collection methods included interviews with family members of older people with dementia and 30 hr of participant observation working alongside emergency nurses. This study was guided by the Standards for Reporting Qualitative Research. RESULTS Two themes emerged from the analysis: What matters to family members with four subthemes and challenges for family members and nurses in the emergency department with two subthemes. CONCLUSION This study demonstrates that some emergency nurses are connecting with family members even in the briefest of clinical encounters. It is feasible for more emergency nurses to do the same more of the time. RELEVANCE TO CLINICAL PRACTICE The older person with dementia must be given a triage category of no less than 3 (to be seen by the doctor within the hour) on arrival in the department. Further education is needed to assist emergency nurses to establish rapport and incorporate family member insights as part of care planning and assessment of the needs of the older person with dementia.
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Affiliation(s)
- Sarah Watkins
- Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Fiona Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Catriona Kennedy
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, Scotland
| | - Belinda Dewar
- School of Health and Life Sciences, UWS Lanarkshire Campus, South Lanarkshire, Scotland
| | - Margaret Graham
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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