Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Atlanta, Georgia 30322, USA.
J Am Geriatr Soc. 2012 Sep;60(9):1742-8. doi: 10.1111/j.1532-5415.2012.04108.x.
The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care.
在因认知障碍而到急诊科就诊的老年患者中，该人群占比为 21%至 40%。急诊科环境混乱，再加上痴呆症，这给临床带来了一系列不良后果，但目前缺乏相应的应对策略。我们对相关文献进行了回顾，旨在研究针对急诊科环境下痴呆患者（PWD）的护理实践。我们在 PubMed 和 Cumulative Index to Nursing and Allied Health Literature 数据库中搜索了与急诊科 PWD 护理相关的已发表文章。我们对所有英文文章进行了综述，排除了社论和反思性期刊。最终有 7 篇文章符合纳入标准，均为 7 级证据：叙述性综述或权威意见。这些文章提出了一些临床实践建议，可归纳为五个主题：认知障碍评估、痴呆症沟通策略、避免不良事件、调整物理环境和急诊科工作人员教育。许多建议是从养老院环境中推断出来的。综述结果表明，针对急诊科特定环境下 PWD 护理的指导很少。目前没有针对急诊科 PWD 护理（评估、干预）的实证研究。现有的（7 级）建议缺乏支持其有效性或采用作为循证实践的研究基础。有很大的机会进行研究，以确定并测试满足急诊科 PWD 需求的方法，以确保安全就诊、准确诊断，并谨慎将其转移至最合适的护理级别。
