Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review

Cameron J Gettel, Jason R Falvey, Angela Gifford, Ly Hoang, Leslie A Christensen, Ula Hwang, Manish N Shah, GEAR 2.0-ADC Network, Neelum Aggarawal, Heather Allore, Aloysi Amy, Michael Belleville, M Fernanda Bellolio, Marian Emmy Betz, Kevin Biese, Cynthia Brandt, Stacey Bruursema, Ryan Carnahan, Christopher Carpenter, David Carr, Jennie Chin-Hansen, Morgan Daven, Nida Degesys, M Scott Dresden, Jeffrey Dussetschleger, Michael Ellenbogen, Jason Falvey, Beverley Foster, Cameron Gettel, Angela Gifford, Andrea Gilmore-Bykovskyi, Elizabeth Goldberg, Jin Han, James Hardy, S Nicole Hastings, Jon Mark Hirshon, Ly Hoang, Tess Hogan, William Hung, Ula Hwang, Eric Isaacs, Naveena Jaspal, Deb Jobe, Jerry Johnson, Kathleen Kathy Kelly, Maura Kennedy, Amy Kind, Jesseca Leggett, Michael Malone, Michelle Moccia, Monica Moreno, Nancy Morrow-Howell, Armin Nowroozpoor, Ugochi Ohuabunwa, Brenda Oiyemhonian, William Perry, Beth Prusaczk, Jason Resendez, Kristen Rising, Mary Sano, Bob Savage, Manish Shah, Joe Suyama, Jeremy Swartzberg, Zachary Taylor, Tolia Vaishal, Allan Vann, Teresa Webb, Sandra Weintraub, Cameron J Gettel, Jason R Falvey, Angela Gifford, Ly Hoang, Leslie A Christensen, Ula Hwang, Manish N Shah, GEAR 2.0-ADC Network, Neelum Aggarawal, Heather Allore, Aloysi Amy, Michael Belleville, M Fernanda Bellolio, Marian Emmy Betz, Kevin Biese, Cynthia Brandt, Stacey Bruursema, Ryan Carnahan, Christopher Carpenter, David Carr, Jennie Chin-Hansen, Morgan Daven, Nida Degesys, M Scott Dresden, Jeffrey Dussetschleger, Michael Ellenbogen, Jason Falvey, Beverley Foster, Cameron Gettel, Angela Gifford, Andrea Gilmore-Bykovskyi, Elizabeth Goldberg, Jin Han, James Hardy, S Nicole Hastings, Jon Mark Hirshon, Ly Hoang, Tess Hogan, William Hung, Ula Hwang, Eric Isaacs, Naveena Jaspal, Deb Jobe, Jerry Johnson, Kathleen Kathy Kelly, Maura Kennedy, Amy Kind, Jesseca Leggett, Michael Malone, Michelle Moccia, Monica Moreno, Nancy Morrow-Howell, Armin Nowroozpoor, Ugochi Ohuabunwa, Brenda Oiyemhonian, William Perry, Beth Prusaczk, Jason Resendez, Kristen Rising, Mary Sano, Bob Savage, Manish Shah, Joe Suyama, Jeremy Swartzberg, Zachary Taylor, Tolia Vaishal, Allan Vann, Teresa Webb, Sandra Weintraub

Abstract

Objectives: 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.

Design: Systematic scoping review.

Setting and participants: ED patients with cognitive impairment and/or their care partners.

Methods: 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.

Results: 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.

Conclusions and implications: 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.

Keywords: Care transitions; cognitive impairment; emergency department; patient-centered outcomes.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram of the study selection and abstraction process for the current scoping review.

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Source: PubMed

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