Enhancing Emergency Care for Persons Living with Dementia: Innovation and Age-friendly Approaches in Three Emergency Departments

Background: Three San Francisco health system emergency departments have developed Geriatric Emergency Department (GED) models of care programs supporting and providing care for emergency department (ED) patients at risk for or living with dementia. Each system recognized: 1) the high proportion of older adult ED patients and those at risk for dementia, 2) the need to identify cognitive impairment in older adult ED patients, 3) the importance of developing approaches to connect older adult ED patients and their care partners with resources and diagnostic specialty services. Methods: We describe how each hospital adopted and implemented pragmatic GED models of care to support and improve care for ED patients at risk or living with dementia. We also report the proportion of ED encounters made by patients with dementia histories and the number of these reached by GED programs. Results: Three San Francisco hospitals (a tertiary care, critical access, and large integrated health system-community ED) independently implemented GED programs to support and enhance emergency care for patients living with dementia. Each uses screening and assessment tools to identify patients at risk for cognitive impairment. Each captures screening and assessment data to facilitate care and resources for post-discharge care, ensuring coordinated transitions and support for older adults. Programs varied by target patient population age and staff and resource allocation to support program goals. Site-specific pathways differed by location, patient populations, and support from geriatrics, emergency medicine, palliative medicine, neurology, psychiatry, pharmacy, referral processes, and/or pastoral care. Conclusions: Developing GED care interventions that facilitate care for patients at risk of or living with dementia is possible and sustainable when the pathway aligns with health system leadership goals through persistent value demonstration, communication, and promotion. Ultimately, developing and disseminating models of GED care is designed to address geriatric syndromes inclusive of dementia care through continuous quality improvement.