Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Am Med Dir Assoc. 2022 Aug;23(8):1314.e1-1314.e29. doi: 10.1016/j.jamda.2022.05.024.
To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities.
Systematic scoping review.
PLWDs in the ED.
The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities.
From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs.
A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.
总结针对痴呆患者（PLWDs）的最佳急诊（ED）护理实践的研究，并制定研究重点。
系统范围审查。
ED 中的 PLWDs。
制定了以下患者干预比较结局（PICO）问题：PICO1，哪些急诊护理内容可以改善痴呆患者的以患者为中心的结局？PICO2，痴呆患者的急诊护理需求与急诊部门的其他患者有何不同？按照 PRISMA-ScR 指南进行了范围审查，并向老年急症护理应用研究 2.0 推进痴呆护理网络展示，以告知研究重点。
从 6348 篇已确定的出版物中，有 23 篇用于 PICO1，26 篇用于 PICO2。PLWDs 的急诊护理注意事项包括功能依赖、痴呆的行为和心理症状以及疼痛的识别和管理。描述了 ED 护理流程、ED 环境以及满足 PLWD 基本需求方面的问题。全面的老年评估和专门的 ED 病房、家庭医院计划以及低刺激床位遮阳和无接触式监测都显示出改善了以患者为中心或医疗保健使用结果。但是，所有这些都是在单个地点进行的研究，评估了不同的结果。这些结果为以下研究重点提供了信息：（1）培训和痴呆护理能力；（2）以患者和护理人员为中心的评估干预措施；（3）社区和身份因素对 PLWDs 急诊护理的影响；（4）解决可行性的经济或其他实施科学措施；以及（5）改变环境、运营、人员、系统或政策以改善 PLWDs 的 ED 护理。
已经研究了针对 PLWDs 的 ED 护理实践和 ED 护理需求的广泛内容。尽管许多干预措施显示出积极的结果，但缺乏深度和可复制的结果阻止了针对 PLWDs 的 ED 护理最佳实践的具体建议。
