Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada.
CJEM. 2023 Nov;25(11):884-892. doi: 10.1007/s43678-023-00578-z. Epub 2023 Sep 2.
Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis.
We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30 days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I statistic and considered [Formula: see text] > 50% to indicate substantial heterogeneity. All analyses were performed in R software.
We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5 years or greater) and 18.9% (5 years or less).
Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.
与年轻患者相比，老年患者到急诊科（ED）就诊的比例更高。然而，对于患有痴呆症的老年患者到 ED 就诊和再次就诊的频率知之甚少。我们进行了一项系统评价和荟萃分析，以量化有痴呆症诊断的老年患者到 ED 再次就诊的比例。
我们检索了 MEDLINE、Embase 和 CINAHL 以及灰色文献，以确定报告有痴呆症的老年患者在之前 ED 就诊后 30 天内再次到 ED 就诊的观察性研究。我们使用随机效应模型计算 30 天内再次就诊的汇总率作为百分比，并按研究数据源、研究人群和研究期间进行分层分析。我们使用 I 统计量评估研究之间的异质性，并认为 [Formula: see text] > 50% 表示存在显著异质性。所有分析均在 R 软件中进行。
我们确定了 6 篇纳入的文章。患有痴呆症的老年患者在 30 天内再次到 ED 就诊的比例从 16.1%到 58.0%不等。总体再就诊率为 28.6%，存在显著异质性。所有分层分析的研究之间异质性也很高。按数据源，30 天再就诊比例为 52.3%（公立医院）和 20.0%（行政数据库）；按研究人群，再就诊比例为 33.5%（痴呆症为主要人群）和 19.8%（痴呆症为亚组）。按研究期间，再就诊比例为 41.2%（5 年或以上）和 18.9%（5 年或以下）。
关于患有痴呆症的老年患者到 ED 再次就诊的现有文献强调了与出院和随访护理相关的医疗复杂性和挑战，这可能导致这些患者以更高的频率寻求 ED 护理。ED 工作人员可以在将患者和护理人员与更合适的医疗和社会资源联系起来方面发挥重要作用，以便为患者提供更有效和全面的护理方法。
