Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
J Am Med Dir Assoc. 2022 Aug;23(8):1313.e1-1313.e13. doi: 10.1016/j.jamda.2022.01.076. Epub 2022 Mar 2.
We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.
Systematic scoping review.
ED patients with cognitive impairment and/or their care partners.
Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.
From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.
This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.
本研究旨在描述针对认知障碍老年患者的急诊科（ED）照护交接干预措施，确定相关以患者为中心的结局，并确定未来研究的重点领域。
系统范围界定综述。
ED 中有认知障碍和/或其照顾者的患者。
根据临床问题，我们按照已发表的指南，对医学研究数据库进行了系统的电子检索，以寻找相关文献。研究结果提供给了一个代表 ED 内和非 ED 内临床医生、认知障碍患者、照顾者和倡导组织的利益相关者小组。经过讨论，他们对未来调查的优先研究领域进行了投票。
从 3848 篇已确定的文献中，有 78 篇符合条件的研究进行了全文审查，10 篇文章进行了摘要。针对认知障碍老年患者的常见 ED 到社区的照护交接干预措施包括多学科老年评估、医疗人员家访和电话随访。干预效果不一，30 天内 ED 复诊率有所改善，但在促进与门诊护理的联系或改善身体功能等次要结局方面大多无效。认知障碍患者及其照顾者认为重要的结局包括提供者之间的照护协调以及在 ED 环境中让照顾者参与照护管理。利益相关者确定的未来研究的重点领域是确定针对因社会孤立或经济劣势等其他脆弱性而使认知障碍复杂化的成年人的 ED 到社区的照护交接的策略。
本范围界定综述确定了针对认知障碍老年患者的 ED 到社区的照护交接干预措施中的关键差距。结合利益相关者的评估和优先级排序，确定了相关以患者为中心的结局，并明确了未来研究的重点领域，以改善 ED 对认知障碍患者的护理，鉴于当前的人口趋势，这是一个急需解决的领域。
