A Systematic Review of Interventions for Persons Living With Dementia: The Geriatric ED Guidelines 2.0.
Sangil Lee, Michelle Suh, Luna Ragsdale, Justine Seidenfeld, James D van Oppen, Lauren Lapointe-Shaw, Carolina Diniz Hooper, James Jaramillo, Annie B Wescott, Kaiho Hirata, Maura Kennedy, Lauren Cameron Comasco, Christopher R Carpenter, Teresita M Hogan, Shan W Liu, Geriatric ED Guidelines dementia writing group
Author Information
Sangil Lee: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Michelle Suh: Section of emergency medicine, University of Chicago, Chicago, IL.
Luna Ragsdale: Chief, Emergency Department, Durham VA Healthcare System; Clinical Associate, Department of Emergency Medicine, Duke University Hospital.
Justine Seidenfeld: Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.
James D van Oppen: Centre for Urgent and Emergency Care Research, University of Sheffield, S1 4DA, UK.
Lauren Lapointe-Shaw: Department of Medicine, University of Toronto, Toronto, Canada.
James Jaramillo: Frank H. Netter MD School of Medicine, Quinnipiac University.
Annie B Wescott: Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University.
Kaiho Hirata: Department of Emergency Medicine, International University of Health and Welfare Narita, Chiba, Japan.
Maura Kennedy: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School.
Lauren Cameron Comasco: Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Christopher R Carpenter: Department of Emergency Medicine, Mayo Clinic, Rochester, MN. ORCID
Teresita M Hogan: Department of Medicine, Section of Emergency Medicine, Section of Geriatrics & Palliative Care, University of Chicago, Chicago, IL.
Shan W Liu: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School.
Background: The increasing prevalence of dementia poses significant challenges for emergency department (ED) care, as persons living with dementia (PLWD) more frequently experience adverse outcomes such as delirium, prolonged stays, and higher mortality rates. Despite advancements in care strategies, a critical gap remains in understanding how ED interventions impact outcomes in this vulnerable population. This systematic review aims to identify evidence-based ED care interventions tailored to PLWD to improve outcomes. Methods: A systematic review was conducted in Ovid MEDLINE, Cochrane Library (Wiley), Scopus (Elsevier), and ProQuest Dissertations & Theses Global through September 2024. The review protocol was registered on PROSPERO (CRD42024586555). Eligible studies included randomized controlled trials, observational studies, and quality improvement initiatives focused on ED interventions for PLWD. Data extraction and quality assessment were performed independently by two reviewers, with disagreements resolved through discussion. Outcomes included patient satisfaction, ED revisits, functional decline, and mortality. Results: From 3,305 screened studies, six met the inclusion criteria. Interventions included nonpharmacologic therapies (e.g., music and light therapy), specialized geriatric ED units, and assessment tools, such as for pain. Tailored interventions including geriatric emergency units and community paramedic care transitions were effective in reducing 30-day ED revisits and hospitalizations. However, heterogeneity in study designs and outcomes precluded meta-analysis. Risk of bias ranged from low to moderate. Conclusion: This review underscores the urgent need for standardized and evidence-based interventions in ED settings for PLWD. Approaches including multidisciplinary care models and non-pharmacologic therapies demonstrated potential for improving outcomes. Future research should prioritize consistent outcome measures, interdisciplinary collaboration, and person-centered care strategies to enhance the quality and equity of ED services for PLWD.
