Know me – A new person-centered approach for dementia-friendly emergency department care

Abstract

A visit to an emergency department can be a disorientating experience for someone with dementia. Empowered caregivers can mitigate harm stemming from communication issues to support a successful emergency department visit. A qualitative study determined the feasibility of the structure, format, and content of eight hospital-readiness communication tools. Data collection involved English and French-language caregiver focus groups in two Canadian provinces. Study findings have the potential to (a) improve safety in emergency care to older people with dementia and their caregivers, and (b) offer cost-effective communication tools for web-based knowledge translation activity in acute care.

Keywords

emergency department dementia communication safety caregiver empowerment

Get full access to this article

View all access options for this article.

References

Akinyemi

R. O.

Mukaetova-Ladinska

E. B.

Attems

Ihara

Kalaria

R. N.

(2013) Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer’s disease and vascular dementia. Current Alzheimer Research 10(6): 642–653.

Alzheimer’s Association (2013) Alzheimer’s disease facts and figures. Alzheimer’s & Dementia 9(2): 208–245, . Retrieved from http://www.alz.org/downloads/facts_figures_2013.pdf.

Alzheimer’s Disease International. (2013). World Alzheimer report 2013: An analysis of long-term care for dementia. Retrieved from http://www.alz.co.uk/research/world-report-2013.

Alzheimer Society of Canada (2011) Guidelines for care: Person-centred care for people with dementia living in care homes, Toronto: Alzheimer Society of CanadaRetrieved from http://www.alzheimer.ca/culturechange.

Alzheimer Society of Canada. (2015). All about me, a conversation starter. Retrieved from http://www.alzheimer.ca/allaboutme.

Baillie

Cox

Merritt

(2012) Caring for older people with dementia in hospital. Part One: Challenges. Nursing Older People 24(8): 33–37.

Calnan

Tadd

Calnan

Hillman

Read

Bayer

(2013) ‘I often worry about the older person being in that system’: Exploring the key influences on the provision of dignified care for older people in acute hospitals. Ageing and Society 33: 465–485. DOI:10.1017/S0144686X12000025.

Clevenger

C. K.

Chu

T. A.

Yang

Hepburn

K. W.

(2012) Clinical care of persons with dementia in the emergency department: A review of the literature and agenda for research. Journal of the American Geriatrics Society 60(9): 1742–1748. DOI:10.1111/j.1532-5415.2012.04108.x.

Dewing

Dijk

(2016) What is the current state of care for older people with dementia in general hospital? A literature review. Dementia 15(1): 106–124. DOI:10.1177/1471301213520172.

10.

Dupuis

Wiersma

Loiselle

(2012) Pathologizing behaviour: Meanings of behaviours in dementia care. Journal of Aging Studies 26(2): 162–173.

11.

Edvardsson

Fetherstonhaugh

Nay

(2010) Promoting a continuation of self and normality: Person-centered care as described by people with dementia, their family members and aged care staff. Journal of Clinical Nursing 19: 2611–2618. DOI:10.1111/j.1365-2702.2009.03143.x.

12.

Feldman

M. A.

Owen

Andrews

Hamelin

Barber

Griffiths

(2012) Health self-advocacy training for persons with intellectual disabilities. Journal of Intellectual Disability Research 56(11): 1110–1121. DOI:10.1111/j.1365-2788.2012.01626.x.

13.

Feng

Coots

L. A.

Kalaganova

Wiener

J. M.

(2014) Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Affairs 33(4): 683–690. DOI:10.1377/hlthaff.2013.1179.

14.

Hoppa

E. C.

Porter

S. C.

(2011) A content analysis of parents’ written communication of needs and expectations for emergency care of their children. Pediatric Emergency Care 27(6): 507–513. DOI: 10.1097/PEC.06013e31821d865e.

15.

Hustey

F. M.

Meldon

S. W.

(2002) The prevalence and documentation of impaired mental status in elderly emergency department patients. Annals of Emergency Medicine 39(3): 248–253.

16.

Jurgens

F. J.

Clissett

Gladman

J. R. F.

Harwood

R. H.

(2012) Why are family carers of people with dementia dissatisfied with general hospital care? A qualitative study. BioMed Central Geriatrics 12: 57, . Retrieved from http://www.biomedcentral.com/1471-2318/12/57.

17.

Kidd

Parshall

(2000) Getting the focus and the group: Enhancing analytical rigor in focus group research. Qualitative Health Research 10(3): 293–308.

18.

LaMantia

M. A.

Stump

T. E.

Messina

F. C.

Miller

D. K.

Callahan

C. M.

(2016) Emergency department use among older adults with dementia. Alzheimer Disease Association Disorder 30: 35–40. Retrieved from www.alzheimerjournal.com.

19.

(2005) Hospitalized elders and family caregivers: A typology of family worry. Journal of Clinical Nursing 14: 3–8. DOI:10.1111/j.1365-2702.2004.01013.x.

20.

Loisell, C. G., Profetto-McGrath, J., Polit, D. F., & Beck, C. T. (Eds.). (2011). Canadian essentials of nursing research (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

21.

McBride

Burey

Megahed

Feldman

Deaton

(2014) The role of patient-held alert cards in promoting continuity of care for heart failure patients. European Journal of Cardiovascular Nursing 13(1): 71–77. DOI:10.1177/1474515113478531.

22.

Miles

M. B.

Huberman

A. M.

Saldana

(2013) Qualitative data analysis: An expanded sourcebook, 3rd ed.. Thousand Oaks, CA: Sage.

23.

Morse

J. M.

(2000) Determining sample size. Qualitative Health Research 10(1): 3–5.

24.

Murray Alzheimer Research and Education Program. (2012). Responsive behaviours: Definition and philosophy of responsive behaviours. Retrieved from https://uwaterloo.ca/murray-alzheimer-research-andeducation-program/research/projects/responsivebehaviours.

25.

Parke

Beaith

Slater

Clark

A. M.

(2011) Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: A scoping and integrative review. Journal of Advanced Nursing 67(7): 1426–1448.

26.

Parke

Hunter

(2014) The care of older adults in hospital: If it’s just common sense why isn’t it common practice? Journal of Clinical Nursing 23: 1573–1582.

27.

Parke

Hunter

K. F.

Bostrom

A. M.

Chambers

Manraj

(2014) Identifying modifiable factors to improve quality for older adults in hospital: A scoping review. International Journal of Older People Nursing 9(1): 8–24. DOI:10.1111/opn.12007.

28.

Parke

Hunter

Strain

Marck

P. B.

Waugh

E. R.

McClelland

A. J.

(2013) Facilitators and barriers to safe emergency department transitions for community dwelling older people with dementia and their caregivers: A social ecological study. International Journal of Nursing Studies 50(9): 1206–1218.

29.

Phelan

E. A.

Borson

Grothaus

Balch

Larson

E. B.

(2012) Association of incident dementia with hospitalizations. Journal of the American Medical Association 307: 165–172.

30.

Picket

S. A.

Diehl

S. M.

Steigman

P. J.

Prater

J. D.

Fox

Shipley

Cook

J. A.

(2011) Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education. Community Mental Health Journal 48: 420–430. DOI:10.1007/s10597-012-9507-0.

31.

Prince

Bryce

Albanese

Wimo

Ribeiro

Ferri

C. P.

(2013) The global prevalence of dementia: A systematic review and metaanalysis. Alzheimer’s & Dementia 9: 63–75. DOI:10.1016/j.jalz.2012.11.007.

32.

Samaras

Chevalley

Samaras

Gold

(2010) Older patients in the emergency department: A review. Annals of Emergency Medicine 56(3): 261–269.

33.

Schnitker

Martin-Khan

Beattie

Gray

(2011) Negative health outcomes and adverse events in older people attending emergency departments: A systematic review. Australasian Emergency Nursing Journal 14(3): 141–162. DOI:10.1016/j.aenj.2011.04.001.

34.

Schnitker

Martin-Khan

Beattie

Gray

(2013) What is the evidence to guide best practice for the management of older people with cognitive impairment presenting to emergency departments? A systematic review. Advanced Emergency Nursing Journal 35(2): 154–169. DOI:10.1097/TME.0b013e31828c7f4a.

35.

Stiell

Forster

A. J.

Stiell

I. G.

van Walraven

(2003) Prevalence of information gaps in the emergency department and the effect on patient outcomes. Canadian Medical Association Journal 169(10): 1023–1028.

36.

Wagner

L. M.

Huijbregts

Sokoloff

L. G.

Wisniewski

Walsh

Feldman

Conn

D. K.

(2014) Implementation of mental health huddles on dementia care units. Canadian Journal on Aging 33(3): 235–245.

37.

World Health Organization. (2012) Dementia: A public health priority. Retrieved from http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf?ua=1.