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Caring for older people with dementia in the emergency department

25 June 2020
Professional
02 June 2020
Volume 29 · Issue 12

Abstract

Background:

Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice.

Methods:

Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria.

Results:

Three themes were identified: carers and older people with dementia—waiting and worrying; nurses juggling priorities; and strategies for improvement—taking a partnership approach.

Conclusion:

Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed.

Internationally it is estimated that 21–42% of older people attending an emergency department (ED) will have cognitive impairment or dementia (Gagnon-Roy et al, 2018). The World Health Organization (WHO) identifies dementia as a global public health challenge (Wortmann, 2012). It is predicted that the prevalence of dementia will rise to 131.5 million people worldwide by the year 2050 (Digby et al, 2018).

Dementia is an umbrella term used to describe a progressive decline in cognition. The World Alzheimer Report 2019 describes devastating symptoms that compromise the person's ability to fully and equitably engage in everyday activities (Alzheimer's Disease International, 2019). Older people are mostly affected and in the advanced stages of dementia frequently require hospital admission for complications related to infections (Pinkert et al, 2018). Older people with dementia may be treated unfairly in hospital because of their ability to make decisions, including those related to healthcare, is diminished (Alzheimer's Disease International, 2019). As the condition advances, the older person with dementia may have difficulty explaining their symptoms and communicating their past medical history.

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Dementia patients' experiences
Dementia care
Emergency care
Carers
Relationship-centred nursing