Personal Blog #24 … Personal Statement to GEAR 2.0 Task Force ... 8/16/21

The GEAR project … Geriatric Emergency care Applied Research … is winding down its year of having task force domain groups focus on four major areas affecting people with dementia or cognitive impairment in hospital Emergency Departments (EDs).  Groups focused on the best way to detect cognitive impairment/dementia in patients in the ED, the best practices to treat such patients, best ways to communicate with such patients and how to involve care partners in shared decision making, and best ways to facilitate transitions between the ED and home or to other facilities.  Groups worked on preparing questions to research in each area, prioritized questions, and conducted reviews of the literature.  Further discussion and voting will take place at upcoming “consensus conferences in September.  After these top priorities are selected, pilot grants will then be issued to, hopefully, provide some answers.  As stated on their new website, “The mission of the Geriatric Emergency care Applied Research (GEAR) network is to improve the emergency care of older adults and those with dementia and other cognitive impairments.  GEAR looks to identify research gaps in geriatric care and support research and evaluation of these areas”  https://gearnetwork.org/

As a former caregiver who participated in each of the four domain groups … zoom meetings for each domain were held monthly for the past year … I was given the opportunity to prepare a brief personal statement to be shared with participants at the consensus meetings in September.  I viewed this as an opportunity to share what I thought should be the two highest priorities of our group … the two areas needing most change to try to make ED experiences more effective for people with dementia.  Based upon my own experiences with my late wife in EDs, and the experiences of other caregivers who provided me feedback, here is what I prepared for that video statement. 

Should readers have any comments regarding this statement, or comments regarding any of my posted articles and personal blogs, please forward those comments to me at acvann@optonline.net.

Task Force Statement … Allan S. Vann

I am a former Alzheimer’s spouse caregiver.  When in moderate to severe stages, my late wife was brought to a hospital ED on several occasions.  The one common denominator of these ED visits was poor treatment.  I attribute that poor treatment to two overriding reasons … lack of training by ED staff, and the refusal of ED staff to see her as a higher triage priority.

One should expect better outcomes if ED staff are properly trained to diagnose and treat people with dementia, especially those in advanced stages.  Properly trained staff would know, for example, to use non-verbal communication and diagnostic techniques if the dementia patient is unable to understand questions or respond accurately.  If brought to the ED in pain after a fall, for example, it is futile to ask where the pain is or ask on a scale of 1-10 how much it hurts.  A knowledgeable physician might slowly apply pressure to different parts of the patient’s body to note reactions that would often indicate where and how severe the pain is.  Well-trained staff would also understand the value of asking caregivers, if present, for helpful information.

If dementia patients were a higher triage priority, issues in EDs that can unnecessarily cause increased discomfort and pain, let alone complicate diagnosis and treatment, could be lessened dramatically.  Issues such as increased anxiety, sundowning, restlessness, disorientation, and heightened confusion due to long waits for examination and diagnostic testing followed by longer waits for results of such testing, IV needles in arms for many hours, sensory overload due to bright overhead lighting, sounds of machines beeping and strangers and staff talking, lying on uncomfortable gurneys, effects of delays in taking daily medications which may specifically help lessen anxiety, increasing fatigue due to not eating until all testing is complete, and the list  goes on … all of these issues can be lessened to a great extent if people with dementia were a higher triage priority.  Inattention to these matters can also mask or exacerbate the very issues that led to the ED visit, or even cause new health issues, so ED staff must also recognize that it is extremely important to reach decisions to admit or discharge as quickly as possible.  

Many other spouse caregivers have shared similar ED experiences with me.  ED staff responsible for treating people with dementia need more and better education and training, and dementia patients must be given a higher triage priority.