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Editorial| Volume 23, ISSUE 8, P1288-1290, August 2022

The Geriatric-Focused Emergency Department: Opportunities and Challenges

  • Philip D. Sloane
    Correspondence
    Address correspondence to Philip D. Sloane, MD, MPH, Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, CB 7590, Chapel Hill, NC 27599, USA.
    Affiliations
    Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    Search for articles by this author
DOI:https://doi.org/10.1016/j.jamda.2022.06.017
The Geriatric-Focused Emergency Department: Opportunities and Challenges
Previous ArticleAdapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference
Next ArticleNursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers
      Emergency departments are an important site of medical care for older persons and serve as a gateway to hospital entry. In the United States, persons aged 65 years and older comprise 18% of emergency department visits and a whopping 40% of emergency department-to-hospital admissions.
      National Center for Health Statistics, US Department of Health and Human Services
      National Hospital Ambulatory Medical Care Survey: 2018 emergency department summary tables.
      https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf
      Date accessed: June 14, 2022
      The primary focus of emergency departments is acute, potentially life-threatening conditions, which has led these settings to be characterized by a restive staff mindset, limited history taking, extensive use of laboratory and radiologic tests, and a focus on rapid decision making and patient disposition. This approach is in many ways antithetical to care of older persons, for which the key elements of quality include concern for comfort and homeostasis, understanding of the patient’s complex medical and psychosocial history, avoidance of unnecessary interventions, and observation over time.
      In the emergency department setting, it is not uncommon for older persons and their family caregivers to report less-than-satisfactory experiences, citing unpleasant waiting conditions, unhelpful staff attitudes toward patients, lack of communication, and inattention to privacy and personal care.
      • Mwakilasa M.T.
      • Foley C.
      • O'Carroll T.
      • Flynn R.
      • Rohde D.
      Care experiences of older people in the emergency department: a concurrent mixed-methods study.
      J Patient Exp. 2021; 8 (23743735211065267)
      ,
      • Landau S.F.
      • Bendalak J.
      • Amitay G.
      • Marcus O.
      Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study.
      Isr J Health Policy Res. 2018; 7: 6
      In addition, the lack of attention among emergency departments to the peculiarities of older patients has been associated with such negative outcomes as overdiagnosis of urinary infection and unnecessary hospitalization, and these have been linked to insufficient provider knowledge, negative attitudes, health system deficiencies, and suboptimal communication.
      • Caterino J.M.
      • Ting S.A.
      • Sisbarro S.G.
      • Espinola J.A.
      • Camargo Jr., C.A.
      Age, nursing home residence, and presentation of urinary tract infection in U.S. emergency departments, 2001-2008.
      Acad Emerg Med. 2012; 19: 1173-1180
      ,
      • Van den Broek S.
      • Heiwegen N.
      • Verhofstad M.
      • et al.
      Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals.
      BMJ Open. 2020; 10: e040431
      I spent many years providing physician services in a small rural emergency department and can attest that many of the most challenging patients were geriatric. My training and experience in geriatric medicine put me in an excellent position to understand and address many of their unique issues and to communicate effectively with patients, families, and, when appropriate, long-term care settings.
      My experience is by no means unique. Indeed, the field of emergency medicine has become increasingly focused on improving services for older persons by promoting age-friendly emergency department facility design, staff education, policies, and procedures. Milestones in this move have included establishment of career development awards to foster leaders in emergency medicine who focus on older persons

      Rosen T, Shah M, Lundebjerg NE, et al. Impact of Jahnigen/GEMSSTAR scholarships on careers of recipients in emergency medicine and on development of geriatric emergency medicine. Acad Emerg Med. Published online March 1, 2018

      ; joint development and publication of guidelines for geriatric emergency departments by the American College of Emergency Physicians, the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine
      • Carpenter C.R.
      • Bromley M.
      • Caterino J.M.
      • et al.
      Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
      Acad Emerg Med. 2014; 21: 806-809
      ; and launch of the American College of Emergency Physicians’ geriatric emergency department accreditation program.
      • Southerland L.T.
      • Lo A.X.
      • Biese K.
      • et al.
      Concepts in practice: geriatric emergency departments.
      Ann Emerg Med. 2020; 75: 162-170
      ,
      American College of Emergency Physicians
      Geriatric Emergency Department Accreditation Program.
      https://www.acep.org/geda/
      Date accessed: June 14, 2022
      Characteristics of a fully operationalized geriatric-friendly emergency department include
      • •
        a multidisciplinary staff of geriatric-trained providers, including leaders in medicine, nursing, and ancillary services, and encouragement of geriatric-specific training for all staff, including subspecialty consultants and ancillary service providers;
      • •
        architectural design that provides privacy, avoids patient placement in hallways and multioccupant rooms, minimizes noise in holding and examination areas, and provides soft lighting in common areas but task lighting when appropriate;
      • •
        equipment and supplies that are appropriate for older persons, such as furniture designed for persons with mobility issues and high risk of skin breakdown, and availability and use of care aids such as walking devices, hearing aids, condom catheters, and bedside commodes;
      • •
        protocols in place that ensure appropriate communication of relevant information to the patient and family and to primary care providers at the time of discharge, using appropriate modalities such as large print discharge instructions and electronic communication of key elements of the visit and care plan;
      • •
        polices, procedures, and protocols to address common problematic areas, including screening and assessment for geriatric syndromes such as frailty and delirium, use of urinary catheters, medication management, falls assessment, care of persons with acute and longstanding cognitive impairment, and assessment for and implementation of palliative care approaches when appropriate;
      • •
        an ongoing educational program for staff and community linkages (eg, emergency medical services providers), based on periodic needs assessments; and
      • •
        ongoing quality improvement under the leadership of a geriatric medical director and geriatric nurse manager, which includes indicators, data collection, and ongoing assessment of progress and goal revision. Typical target areas for quality improvement include falls, use of urinary catheters, delirium assessment and care, and medication issues (eg, high-risk medications and adverse reactions).
        American College of Emergency Physicians
        The American Geriatrics Society, Emergency Nurses Association, and the Society for Academic Emergency Medicine. Geriatric Emergency Department Guidelines.
        https://onlinelibrary-wiley-com.libproxy.lib.unc.edu/action/downloadSupplement?doi=10.1111%2Facem.12415&file=acem12415-sup-0001-DataSupplementS1.pdf
        Date accessed: June 18, 2022
      Improving the geriatric friendliness of emergency departments requires organizational change. Three general implementation models have been described, all of which require a champion at a high administrative level: (1) creating a geriatric-focused subunit in the emergency department, similar to the pediatric subunits in many existing emergency departments; (2) focusing on training of all staff, without specialized providers or settings; and (3) having 1 or more specialized staff (eg, a geriatric nurse practitioner and social worker) who exclusively treat older patients.
      • Southerland L.T.
      • Lo A.X.
      • Biese K.
      • et al.
      Concepts in practice: geriatric emergency departments.
      Ann Emerg Med. 2020; 75: 162-170
      Much work is needed, however, to see the principles of geriatric-friendly emergency department care fully implemented. Key elements of change include focusing on patient preferences and individual situations, rather than on generic and often disease-focused guidelines; increasing the knowledge and expertise of emergency department professionals regarding the unique aspects of geriatric science and care (eg, frailty assessment, person-centered focus, advance directives, palliative care), and increasing the evidence base through research.
      • Mooijaart S.P.
      • Carpenter C.R.
      • Conroy S.P.
      Geriatric emergency medicine—a model for frailty friendly healthcare.
      Age Ageing. 2022; 51: afab280
      As in virtually every aspect of geriatric medicine, high-level evidence to guide practice redesign and protocol development is rare, so research is an important priority if services are to continue to improve. Table 1 lists a few of the areas where research is beginning to appear, but much more needs to be done.
      Table 1Areas of Ongoing Research in Emergency Department Care of Older Persons
      • Experiences of older persons and their family caregivers in emergency departments
      • Gruneir A.
      • Silver M.J.
      • Rochon P.A.
      Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs.
      Med Care Res Rev. 2011; 68: 131-155
      , 
      • Griffey R.T.
      • Schneider R.M.
      • Adler L.
      • Todorov A.
      Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
      J Am Med Dir Assoc. 2021; 22: 907-912.e1
      , 
      • Lucke J.A.
      • Mooijaart S.P.
      • Heeren P.
      • et al.
      Providing care for older adults in the emergency department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.
      Eur Geriatr Med. 2022; 13: 309-317
      • Incorporation of elements of geriatric assessment into routine emergency department practice around such issues as frailty assessment,
      • Lucke J.A.
      • Mooijaart S.P.
      • Heeren P.
      • et al.
      Providing care for older adults in the emergency department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.
      Eur Geriatr Med. 2022; 13: 309-317
      , 
      • Chong E.
      • Zhu B.
      • Tan H.
      • et al.
      Emergency department interventions for frailty (EDIFY): front-door geriatric care can reduce acute admissions.
      J Am Med Dir Assoc. 2021; 22: 923-928.e5
      , 
      • Covino M.
      • Russo A.
      • Salini S.
      • et al.
      Frailty assessment in the emergency department for risk stratification of COVID-19 patients aged ≥80 years.
      J Am Med Dir Assoc. 2021; 22: 1845-1852.e1
      , 
      • Schuster S.
      • Singler K.
      • Lim S.
      • et al.
      Quality indicators for a geriatric emergency care (GeriQ-ED) - an evidence-based Delphi consensus approach to improve the care of geriatric patients in the emergency department.
      Scand J Trauma Resusc Emerg Med. 2020; 28: 68
      and tailoring of service delivery to persons with high frailty scores
      • Baldevarona-Llego J.
      • Zhu B.
      • Chong E.
      Emergency department staff perceptions of Emergency Department Interventions for Frailty (EDIFY).
      J Am Med Dir Assoc. 2022; 23: 179-181.e3
      • Prognosis, risk, and functional trajectories of older persons who present for emergency care
      • Guion V.
      • De Souto Barreto P.
      • Rolland Y.
      Nursing home residents' functional trajectories and mortality after a transfer to the emergency department.
      J Am Med Dir Assoc. 2021; 22: 393-398.e3
      ,
      • Rolland Y.
      • Mathieu C.
      • Tavassoli N.
      • et al.
      Factors associated with potentially inappropriate transfer to the emergency department among nursing home residents.
      J Am Med Dir Assoc. 2021; 22: 2579-2586.e7
      • Who, when, and under what circumstances to conduct diagnostic testing
      • Kunkel E.
      • Tanuseputro P.
      • Hsu A.
      • et al.
      Diagnostic testing in long-term care and resident emergency department visits: a retrospective cohort study.
      J Am Med Dir Assoc. 2021; 22: 901-906.e4
      • Geriatric-specific guidelines for medication use
      • Lucke J.A.
      • Mooijaart S.P.
      • Heeren P.
      • et al.
      Providing care for older adults in the emergency department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.
      Eur Geriatr Med. 2022; 13: 309-317
      • Appropriate use of emergency departments by long-term care facilities, and improved methods of acute care in the facility
      • Griffey R.T.
      • Schneider R.M.
      • Adler L.
      • Todorov A.
      Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
      J Am Med Dir Assoc. 2021; 22: 907-912.e1
      ,
      • Aryal K.
      • Mowbray F.
      • Gruneir A.
      Nursing home resident admission characteristics and potentially preventable emergency department transfers.
      J Am Med Dir Assoc. 2022; 23: 1291-1296
      , 
      • McNabney M.K.
      • et al.
      How should assisted living be using emergency departments?.
      J Am Med Dir Assoc. 2021; 22: 899-900
      , 
      • Gruber-Baldini A.L.
      • Quinn C.C.
      • Roggio A.X.
      • et al.
      Telemedicine for older adult nursing home residents to avoid emergency department visits: the experience of the NHTeleED Project in Maryland.
      J Am Med Dir Assoc. 2022; 23: 1311-1312
      , 
      • Guerbaai R.A.
      • Kressig R.W.
      • Zeller A.
      Identifying appropriate nursing home resources to reduce fall-related emergency department transfers.
      J Am Med Dir Assoc. 2022; 23: 1304-1310
      • Under what circumstances and how best to fold in discussion of and decision making regarding limitation of treatment, advance directives, and palliative care
      • Rosenberg M.
      • Lamba S.
      • Misra S.
      Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles.
      Clin Geriatr Med. 2013; 29: 1-29
      , 
      • da Silva Soares D.
      • Nunes C.M.
      • Gomes B.
      Effectiveness of emergency department based palliative care for adults with advanced disease: a systematic review.
      J Palliat Med. 2016; 19: 601-609
      , 
      • Williamson L.E.
      • Evans C.J.
      • Cripps R.L.
      • et al.
      Factors associated with emergency department visits by people with dementia near the end of life: a systematic review.
      J Am Med Dir Assoc. 2021; 22: 2046-2055.e35
      • Care of persons with Alzheimer’s disease and related dementias in emergency department settings
      • Carpenter C.R.
      • Dresden S.M.
      • Shah M.N.
      • Hwang U.
      Adapting emergency care for persons living with dementia: results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference.
      J Am Med Dir Assoc. 2022; 23: 1286-1287
      Of all aspects of geriatric emergency department care, perhaps the most need is for system change related to care of persons with Alzheimer’s disease and related dementias (ADRD), and the research to guide that change.
      • Williamson L.E.
      • Evans C.J.
      • Cripps R.L.
      • et al.
      Factors associated with emergency department visits by people with dementia near the end of life: a systematic review.
      J Am Med Dir Assoc. 2021; 22: 2046-2055.e35
      ,
      • Carpenter C.R.
      • Dresden S.M.
      • Shah M.N.
      • Hwang U.
      Adapting emergency care for persons living with dementia: results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference.
      J Am Med Dir Assoc. 2022; 23: 1286-1287
      Fortunately, with support from the US National Institute on Aging, a recent series of studies has focused on this issue, resulting in separate reviews on detecting cognitive impairment and dementia in emergency department settings,
      • Nowroozpoor A.
      • Dussetschleger J.
      • Perry W.
      • et al.
      Detecting cognitive impairment and dementia in the ED: a scoping review.
      J Am Med Dir Assoc. 2022; 23 (1314.31-1314-e86)
      communication with persons with ADRD and their families,
      • Carpenter C.R.
      • Leggett J.
      • Bellolio F.
      • et al.
      Emergency department communication in persons living with dementia & care partners: a scoping review.
      J Am Med Dir Assoc. 2022; 23 (1313.e15-1313.e49)
      optimal emergency department services for persons with ADRD,
      • Dresden S.M.
      • Taylor Z.
      • Serina P.
      • et al.
      Optimal emergency department care practices for persons living with dementia: a scoping review.
      J Am Med Dir Assoc. 2022; 23 (1314.e1-1314.e29)
      and management of care transitions in persons with ADRD.
      • Gettel C.J.
      • Falvey J.R.
      • Gifford A.
      • et al.
      Emergency department care transitions for patients with cognitive impairment: a scoping review.
      J Am Med Dir Assoc. 2022; 23 (1313.e1-1313.e13)
      As in virtually all aspects of medicine, progress in improving the care of older persons is incremental and painfully slow. We should have optimism, however, regarding geriatric-friendly emergency department care, because the position of emergency departments in health services, their affiliation with the most influential health care institution (acute care hospitals), the continued increase in the proportion of patients who are older persons, and the growing embrace by emergency department providers of geriatric principles will all serve to stimulate this change. What is needed is more collaboration between hospitals, emergency departments, long-term care settings, and other outpatient providers; increased resources and activity around staff training in geriatric principles; and more research in this understudied and critical area of medical care.

      References

        • National Center for Health Statistics, US Department of Health and Human Services
        National Hospital Ambulatory Medical Care Survey: 2018 emergency department summary tables.
        https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf
        Date accessed: June 14, 2022
        View in Article
        • Mwakilasa M.T.
        • Foley C.
        • O'Carroll T.
        • Flynn R.
        • Rohde D.
        Care experiences of older people in the emergency department: a concurrent mixed-methods study.
        J Patient Exp. 2021; 8 (23743735211065267)
        View in Article
        • Landau S.F.
        • Bendalak J.
        • Amitay G.
        • Marcus O.
        Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study.
        Isr J Health Policy Res. 2018; 7: 6
        View in Article
        • Caterino J.M.
        • Ting S.A.
        • Sisbarro S.G.
        • Espinola J.A.
        • Camargo Jr., C.A.
        Age, nursing home residence, and presentation of urinary tract infection in U.S. emergency departments, 2001-2008.
        Acad Emerg Med. 2012; 19: 1173-1180
        View in Article
        • Van den Broek S.
        • Heiwegen N.
        • Verhofstad M.
        • et al.
        Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals.
        BMJ Open. 2020; 10: e040431
        View in Article

      6. Rosen T, Shah M, Lundebjerg NE, et al. Impact of Jahnigen/GEMSSTAR scholarships on careers of recipients in emergency medicine and on development of geriatric emergency medicine. Acad Emerg Med. Published online March 1, 2018

        View in Article
        • Carpenter C.R.
        • Bromley M.
        • Caterino J.M.
        • et al.
        Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
        Acad Emerg Med. 2014; 21: 806-809
        View in Article
        • Southerland L.T.
        • Lo A.X.
        • Biese K.
        • et al.
        Concepts in practice: geriatric emergency departments.
        Ann Emerg Med. 2020; 75: 162-170
        View in Article
        • American College of Emergency Physicians
        Geriatric Emergency Department Accreditation Program.
        https://www.acep.org/geda/
        Date accessed: June 14, 2022
        View in Article
        • American College of Emergency Physicians
        The American Geriatrics Society, Emergency Nurses Association, and the Society for Academic Emergency Medicine. Geriatric Emergency Department Guidelines.
        https://onlinelibrary-wiley-com.libproxy.lib.unc.edu/action/downloadSupplement?doi=10.1111%2Facem.12415&file=acem12415-sup-0001-DataSupplementS1.pdf
        Date accessed: June 18, 2022
        View in Article
        • Mooijaart S.P.
        • Carpenter C.R.
        • Conroy S.P.
        Geriatric emergency medicine—a model for frailty friendly healthcare.
        Age Ageing. 2022; 51: afab280
        View in Article
        • Gruneir A.
        • Silver M.J.
        • Rochon P.A.
        Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs.
        Med Care Res Rev. 2011; 68: 131-155
        View in Article
        • Griffey R.T.
        • Schneider R.M.
        • Adler L.
        • Todorov A.
        Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
        J Am Med Dir Assoc. 2021; 22: 907-912.e1
        View in Article
        • Lucke J.A.
        • Mooijaart S.P.
        • Heeren P.
        • et al.
        Providing care for older adults in the emergency department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.
        Eur Geriatr Med. 2022; 13: 309-317
        View in Article
        • Chong E.
        • Zhu B.
        • Tan H.
        • et al.
        Emergency department interventions for frailty (EDIFY): front-door geriatric care can reduce acute admissions.
        J Am Med Dir Assoc. 2021; 22: 923-928.e5
        View in Article
        • Covino M.
        • Russo A.
        • Salini S.
        • et al.
        Frailty assessment in the emergency department for risk stratification of COVID-19 patients aged ≥80 years.
        J Am Med Dir Assoc. 2021; 22: 1845-1852.e1
        View in Article
        • Schuster S.
        • Singler K.
        • Lim S.
        • et al.
        Quality indicators for a geriatric emergency care (GeriQ-ED) - an evidence-based Delphi consensus approach to improve the care of geriatric patients in the emergency department.
        Scand J Trauma Resusc Emerg Med. 2020; 28: 68
        View in Article
        • Baldevarona-Llego J.
        • Zhu B.
        • Chong E.
        Emergency department staff perceptions of Emergency Department Interventions for Frailty (EDIFY).
        J Am Med Dir Assoc. 2022; 23: 179-181.e3
        View in Article
        • Guion V.
        • De Souto Barreto P.
        • Rolland Y.
        Nursing home residents' functional trajectories and mortality after a transfer to the emergency department.
        J Am Med Dir Assoc. 2021; 22: 393-398.e3
        View in Article
        • Rolland Y.
        • Mathieu C.
        • Tavassoli N.
        • et al.
        Factors associated with potentially inappropriate transfer to the emergency department among nursing home residents.
        J Am Med Dir Assoc. 2021; 22: 2579-2586.e7
        View in Article
        • Kunkel E.
        • Tanuseputro P.
        • Hsu A.
        • et al.
        Diagnostic testing in long-term care and resident emergency department visits: a retrospective cohort study.
        J Am Med Dir Assoc. 2021; 22: 901-906.e4
        View in Article
        • Aryal K.
        • Mowbray F.
        • Gruneir A.
        Nursing home resident admission characteristics and potentially preventable emergency department transfers.
        J Am Med Dir Assoc. 2022; 23: 1291-1296
        View in Article
        • McNabney M.K.
        • et al.
        How should assisted living be using emergency departments?.
        J Am Med Dir Assoc. 2021; 22: 899-900
        View in Article
        • Gruber-Baldini A.L.
        • Quinn C.C.
        • Roggio A.X.
        • et al.
        Telemedicine for older adult nursing home residents to avoid emergency department visits: the experience of the NHTeleED Project in Maryland.
        J Am Med Dir Assoc. 2022; 23: 1311-1312
        View in Article
        • Guerbaai R.A.
        • Kressig R.W.
        • Zeller A.
        Identifying appropriate nursing home resources to reduce fall-related emergency department transfers.
        J Am Med Dir Assoc. 2022; 23: 1304-1310
        View in Article
        • Rosenberg M.
        • Lamba S.
        • Misra S.
        Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles.
        Clin Geriatr Med. 2013; 29: 1-29
        View in Article
        • da Silva Soares D.
        • Nunes C.M.
        • Gomes B.
        Effectiveness of emergency department based palliative care for adults with advanced disease: a systematic review.
        J Palliat Med. 2016; 19: 601-609
        View in Article
        • Williamson L.E.
        • Evans C.J.
        • Cripps R.L.
        • et al.
        Factors associated with emergency department visits by people with dementia near the end of life: a systematic review.
        J Am Med Dir Assoc. 2021; 22: 2046-2055.e35
        View in Article
        • Carpenter C.R.
        • Dresden S.M.
        • Shah M.N.
        • Hwang U.
        Adapting emergency care for persons living with dementia: results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference.
        J Am Med Dir Assoc. 2022; 23: 1286-1287
        View in Article
        • Nowroozpoor A.
        • Dussetschleger J.
        • Perry W.
        • et al.
        Detecting cognitive impairment and dementia in the ED: a scoping review.
        J Am Med Dir Assoc. 2022; 23 (1314.31-1314-e86)
        View in Article
        • Carpenter C.R.
        • Leggett J.
        • Bellolio F.
        • et al.
        Emergency department communication in persons living with dementia & care partners: a scoping review.
        J Am Med Dir Assoc. 2022; 23 (1313.e15-1313.e49)
        View in Article
        • Dresden S.M.
        • Taylor Z.
        • Serina P.
        • et al.
        Optimal emergency department care practices for persons living with dementia: a scoping review.
        J Am Med Dir Assoc. 2022; 23 (1314.e1-1314.e29)
        View in Article
        • Gettel C.J.
        • Falvey J.R.
        • Gifford A.
        • et al.
        Emergency department care transitions for patients with cognitive impairment: a scoping review.
        J Am Med Dir Assoc. 2022; 23 (1313.e1-1313.e13)
        View in Article

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      DOI: https://doi.org/10.1016/j.jamda.2022.06.017

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      © 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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