Enhancing Emergency Care for Persons Living with Dementia: Innovation and Age-friendly Approaches in Three Emergency Departments
Year: 2026
Type: preprint
Abstract: ABSTRACT 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. KEY POINTS This paper demonstrates the feasibility of implementing Geriatric ED programs with targeted support for people living with or at risk for dementia across three distinct health systems in San Francisco. We describe the reach and implementation processes of each program including commonalities, differences, challenges faced, and opportunities for future improvement. Creating unique care pathways for older adults and those with cognitive impairment in the emergency department (ED) is often guided by health system resources. Assessing cognition and identifying potential dementia is feasible during an ED visit. An interprofessional approach to geriatric ED care is essential to sustainability and success.
Source: medRxiv
Authors: Karen A Hauser, Nida F. Degesys, Eric D. Isaacs, Marlena Tang, Jeremy Swartzberg, Vasili Panopulos, Ann Marie Martin, Vincent X Liu, David Schlessinger, Nasrin A Samady, Rohan Malhotra, Colleen Plimier, Azadeh Hadadianpour, Mitchel D. Erickson, Todd James, Stephanie Rogers, Julia Adler-Milstein, Robert Thombley, Sarah Rosenthal, Anna R. Harris, James Hardy, Maria Raven, Malini Singh, Candace Kim, Rachel Perry, Elizabeth Clevenger, Cecilia Carvajal, Donell Babino, Alicia Gray, Melina Shapiro, Tiffany Chan, Heather Allore, Daniella Meeker, Debra Tomasino, Elyssa FL Grogan, Anna Pepper, Madelynn Wellons, Ula Hwang
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204048868
Cites:
Cited by:
Related to: