Ula Hwang, MD, professor of Emergency Medicine at Yale School of Medicine and co-PI of the research collaboration, the Geriatric Emergency Care Applied Research Network 2.0 – Advancing Dementia Care (GEAR Network), is co-author of a new collection of research papers that set out priority areas to better provide emergency care for people living with dementia in the United States. Four papers and an accompanying editorial were published today in the Journal of the American Medical Directors Association. The GEAR Network is focused on areas of research that need to be undertaken to provide the best care for people living with dementia when they arrive at the emergency department.
While delirium – which, like dementia, also disrupts attention, cognition, and consciousness – has been studied in emergency care, dementia has received less attention. And as the number of individuals with dementia in the U.S. is rapidly increasing due to an aging population, emergency care for people with dementia will be important to fully understand.
The GEAR Network is led by teams from the Yale School of Medicine, the University of Wisconsin School of Medicine and Public Health, Northwestern University Feinberg School of Medicine, and the School of Medicine at Washington University in St. Louis.
People living with dementia are potentially at greater risk for poor outcomes when seeking care at the emergency department, according to Hwang who co-led the research team who developed the recommendations. “Unrecognized dementia can lead to substandard care, safety risks and worse outcomes for patients,” she said. “The goal of this work is to identify the areas of emergency care for people living with dementia that most critically need to be studied, and then address those problems.”
The research team, enabled by funding from the National Institutes of Health and joined by people living with dementia, their care partners, and advocates, began in 2020 to examine gaps in care and assess previous research efforts in health care settings across the country. The team identified three research gaps: a limited quantity of dementia care research in emergency department settings, inadequate reporting around diversity, equity and inclusion related to dementia care in emergency departments, and a need to balance inspiration with pragmatism to advance real-world, impactful solutions in emergency departments.
The researchers also identified specific focus areas for future studies including better recognition of dementia-related cognitive impairment by emergency care providers, improved discharge of patients with cognitive impairment to their homes, improving communication strategies between emergency care providers and patients with dementia and improving the care provided to this population while in the emergency department. The team is committed to addressing and facilitating progress in each of these areas,
“Using its NIH funding, the GEAR team will issue grants to health systems and academic medical centers across the nation to perform research studies that will lead to better emergency care models for people living with dementia,” said co-author and co-PI of GEAR, Manish Shah, MD, MPH, professor of emergency medicine at the University of Wisconsin-Madison School of Medicine and Public Health, and emergency physician, UW Health. “In the end, our goal is to build a system that makes our emergency departments just as safe and effective for our patients living with dementia as they are for anyone else,” Shah said. “We are at the start line, and this work will help get us to the finish line.”
Unrecognized dementia can lead to substandard care, safety risks and worse outcomes for patients, The goal of this work is to identify the areas of emergency care for people living with dementia that most critically need to be studied, and then address those problems.
Ula Hwang, MD
Research papers and editorial:
Editorial:
Research papers:
- “Emergency Department Care Transitions for Patients with Cognitive Impairment: A Scoping Review.”
- Emergency Department Communication in Persons Living with Dementia & Care Partners: A Scoping Review.
- Optimal Emergency Department Care Practices for Persons Living with Dementia: A Scoping Review.
- “Detecting Cognitive Impairment and Dementia in the ED: A Scoping Review.”