Readers familiar with this site will note that I have already posted several Personal Blog columns about the GEAR program … Blogs # 18, 24, and 26 … a federally funded program designed to improve care for people with Alzheimer’s disease (AD) and other forms of dementia in hospital Emergency Departments (EDs). Published manuscripts about the research reviews conducted by the GEAR task force in four focus areas … communication, detection, best practices, and transitions … are now available to read. These articles, as well as additional information about this project, may be accessed in the “Manuscripts and Publications” section of the main GEAR website at https://gearnetwork.org.
In the words of Dr. Chris Carpenter, one of the leaders of
this project, “We
would like to generate some media interest in this effort so that persons living
with dementia and their care partners are aware of this work. The more
folks know the more they can pressure their Congressional leaders to ensure
funding for this research. These citizens can also pressure their local
emergency departments to begin adapting for more dementia-friendly care.”
If
any reader has access to major mass media, it would be wonderful to alert such
media to the availability of these manuscripts to generate more interest in improving
emergency care for dementia patients and increase general awareness of what
must be done. Following are the verbatim
“Conclusions and Implications” sections of the manuscripts dealing with our
four areas of focus. It is hoped that these
articles will lead to future research to develop the most effective strategies
in each area and eventually lead to substantial improvement in how dementia
patients are treated in hospital EDs.
Communication … Conclusions and Implications
This scoping review identified sparse published research to
guide evidence-based communication strategies in the ED for PLWD and their care
partners. Although general themes appear to emerge around rushed communication
and inadequate engagement of care partners, these findings are neither
quantified nor directly linked to ineffective communication. Strategies to
improve ED communication for PLWD do not exist, although educational
interventions outside the ED suggest limited effectiveness. GEAR 2.0-ADC
stakeholders prioritized the identification of barriers and facilitators to
effective ED communication for PLWD.
Detection … Conclusion and Implications
We report the results of 2 systematic scoping reviews
evaluating diagnostic accuracy and feasibility to detect cognitive impairment
and dementia in the ED setting. The GEAR 2.0 Advancing Dementia Care task
force, using these results, developed consensus research priorities practice
gaps to advance the detection of cognitive impairment and dementia in the ED
setting. They include the need for more effective and efficient approaches to
recognize persons at risk for cognitive impairment and dementia. These
approaches should balance the importance of equitable screening and the goal
and the consequences identifying cognitive impairment. These research
priorities will be the basis of future GEAR 2.0 research funding opportunities.
Best Practices … Conclusions and Implications
The results of this scoping review reveal a wide range of
components of both ED care practices and ED care needs for PLWDs. Although many
structural and process interventions show positive results, the lack of depth
and reproducible results prevent specific recommendations on best practices in
ED care for PLWDs. Future research should work to identify improvements in ED
care for PLWDs, address gaps in training, identify priority outcomes, address
community and identity-based factors, and incorporate economic viability and
implementation science
Transitions … Conclusions and Implications
This systematic scoping review found few ED-to-community
care transition interventions targeting cognitively impaired older adults and
their care partners. Further, there was little data identifying care transition
outcomes of importance to these groups. Personalizing care transitions for
these ED patients and measuring what matters most during ED-to-community care
transitions were identified as the highest priority areas for future ED
research involving cognitively impaired older adults and their care partners.
As such, research funding agencies, advocacy groups, and researchers should
focus their resources and efforts on these domains, thereby developing the
science to improve the health of this vulnerable population.
Once again, readers are urged to access https://gearnetwork.org to read the entire articles and learn more about this project.
