Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review.
Scott M Dresden, Zachary Taylor, Peter Serina and 5 others
PMID 35940683WHAT IT FOUND
In ED dementia care, pain documentation improved with PAINAD, but time to pain medicine did not.
A fall prevention program did not reduce falls. Home hospital care reduced agitation and antipsychotic use.
Key findings
01A home hospital program for people with dementia admitted from the ED reduced sleeping disorders, agitation and aggressiveness, feeding disorders, and antipsychotic medication use.
02PAINAD was accepted by ED registered nurses and produced earlier and more complete pain assessments, but it did not affect time to analgesia.
03An ED-based fall prevention program for people with dementia after a fall showed no improvement in future falls, health services use, or mortality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The PICO questions were broad. Definitions of emergency care needs and components of ED care were subjective. Studies used different definitions of people with dementia or cognitive impairment. Title and abstract screening had fair agreement, and full-text screening had moderate agreement. No quality assessment or meta-analysis was performed. Some included studies were conference abstracts only. Studies limited to delirium, dementia detection, communication, or care transitions were excluded. Only English language original research was included. One environment study was mostly in a geriatric-gerontopsychiatric ward, not the ED.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that PAINAD improves pain relief because it increases documentation. The studies showed earlier and more complete pain assessments, but the trial showed no effect on time to analgesia.