Dooley Jemima, Booker Matthew, Barnes Rebecca, Xanthopoulou Penny
Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK.
BMJ Open. 2020 Sep 16;10(9):e037673. doi: 10.1136/bmjopen-2020-037673.
People with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.
Scoping review. The search strategy and data synthesis were informed by people with dementia and carers.
Searches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.
Empirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.
Data were extracted using charting techniques and findings were synthesised according to content and themes.
Of 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.
The scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
由于年龄较大、合并症增加、对他人的依赖性较高以及认知障碍，痴呆症患者在紧急健康状况下更容易出现并发症。本综述探讨了与痴呆症患者紧急护理使用相关的因素以及痴呆症患者、非正式护理人员和专业人员的经历。
范围综述。检索策略和数据综合由痴呆症患者和护理人员提供信息。
对CINAHL、Embase、Medline、PsycINFO、PubMed进行检索，并于2019年1月15日前对手检相关期刊和灰色文献进行检索。
纳入包括所有研究设计的实证研究以及其他探讨痴呆症患者在院前和急诊室环境中紧急护理使用相关因素的已发表文献。两位作者独立筛选纳入研究。
采用图表技术提取数据，并根据内容和主题对研究结果进行综合。
在识别出的2967条记录中，有54项研究纳入本综述。影响紧急护理使用的具体因素包括：（1）与痴呆症同时出现的常见年龄相关疾病，（2）作为诊断的痴呆症增加或减少紧急护理使用，（3）非正式和专业护理人员，（4）患者特征，如年龄较大或行为症状，以及（5）社区支持服务的存在与否。纳入研究报告了紧急护理情况的三个关键组成部分：（1）对患者和痴呆症病情的了解，（2）非紧急健康和社会护理支持不足，以及（3）非正式护理人员教育和压力。
范围综述强调了与紧急护理情况相关的更多有时相互竞争的因素。改善和增加对非紧急情况的社区支持，如综合护理、护理人员教育和痴呆症专家，将既能减少可避免的紧急护理使用，又能改善处于危机中的患者的体验。
