Cognitive Impairment, Delirium, Dementia, Emergency Care
Conditions
Keywords
delirium
Brief summary
This is an observational study of the pragmatic implementation of an ED screening, outpatient referral, and care coordination process for older ED patients who may have UCID.
Detailed description
Embedded pragmatic, implementation pilot that incorporates training, ED assessment for delirium and dementia risk, referral of ED patients with undiagnosed cognitive impairment and dementia for primary care feedback and care recommendations. This pilot would gather observational data evaluating the feasibility of incorporating cognitive impairment screens into routine ED delirium assessments, and developing optimal work flow for identifying and referring ED patients with suspected (undiagnosed) dementia for confirmatory evaluation and care coordination.
Interventions
DIAGNOSTIC_TESTPD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)
1. ED assessment for suspected dementia. 2. positive ED patients referred for outpatient clinic cognitive impairment assessment. 3. positive clinic patients referred to primary care with brain health patient plan.
Sponsors
National Institute on Aging (NIA)
Yale University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults age 65 or older * Discharged from the adult ED at YNHH or the ED at NMH
Exclusion criteria
* Documented or known history of dementia * Alcohol/substance intoxication while in the ED * Non-English or Non-Spanish speaking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Patients With Confirmed Delirium or Dementia | 1 year | percentage of patients discharged from ED positive for delirium or dementia among total number of patients 65+ |
| Rates of Outpatient Assessment Referral of Patients With Suspected Dementia | 30 days | number of patients with appointment to Alzheimer's Dementia Centers or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic |
| Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment | Up to 100 days from ED discharge | number of patients diagnosed with dementia (all categories) among those that completed the outpatient assessment |
| Rates of Connection With Primary Care | 30 days | number of patients with PCP follow-up about brain health plan of the number of patients with outpatient confirmation of Dementia or MCI |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| ED Delirium & Dementia Screening & Outpatient Referral Routine ED screening for delirium and memory problems with referral for outpatient assessment of cognitive impairment.
PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan): 1. ED assessment for suspected dementia.
2\. positive ED patients referred for outpatient clinic cognitive impairment assessment.
3\. positive clinic patients referred to primary care with brain health patient plan. | 100 |
| Total | 100 |
Baseline characteristics
| Characteristic | ED Delirium & Dementia Screening & Outpatient Referral |
|---|---|
| Age, Continuous | 82 years STANDARD_DEVIATION 7.8 |
| Chronic Conditions Diabetes | 33 Participants |
| Chronic Conditions High blood pressure | 73 Participants |
| Chronic Conditions PVD | 4 Participants |
| Chronic Conditions Renal failure | 14 Participants |
| Chronic Conditions Stroke | 14 Participants |
| Chronic Conditions TBI | 2 Participants |
| Dementia or Alzheimer's self report | 20 Participants |
| ED Confusion Assessment Method (CAM) Positive | 7 Participants |
| ED delirium diagnosis | 9 Participants |
| ED Disposition Admitted | 4 Participants |
| ED Disposition Discharged | 88 Participants |
| ED Disposition Observation | 8 Participants |
| Emergency Department (ED) memory screen | 41 Participants |
| Emergency Severity Index Level | 2.7 score on a scale STANDARD_DEVIATION 0.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 91 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race/Ethnicity, Customized Asian | 5 Participants |
| Race/Ethnicity, Customized Black or African American | 29 Participants |
| Race/Ethnicity, Customized Other | 1 Participants |
| Race/Ethnicity, Customized Unknown or not reported | 5 Participants |
| Race/Ethnicity, Customized White | 60 Participants |
| Region of Enrollment United States | 100 participants |
| Sex: Female, Male Female | 63 Participants |
| Sex: Female, Male Male | 37 Participants |
| Top 3 chief complaints per participants self report Abdominal pain | 7 Participants |
| Top 3 chief complaints per participants self report Altered mental status | 21 Participants |
| Top 3 chief complaints per participants self report Fall | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 2 / 100 |
| other Total, other adverse events | 6 / 100 |
| serious Total, serious adverse events | 0 / 100 |
Outcome results
Primary
Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment
number of patients diagnosed with dementia (all categories) among those that completed the outpatient assessment
Time frame: Up to 100 days from ED discharge
Population: 19 completed the outpatient assessment
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ED Delirium & Dementia Screening & Outpatient Referral | Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment | 15 Participants |
Primary
Percentage of Patients With Confirmed Delirium or Dementia
percentage of patients discharged from ED positive for delirium or dementia among total number of patients 65+
Time frame: 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| ED Delirium & Dementia Screening & Outpatient Referral | Percentage of Patients With Confirmed Delirium or Dementia | 30.8 percentage of participants |
Primary
Rates of Connection With Primary Care
number of patients with PCP follow-up about brain health plan of the number of patients with outpatient confirmation of Dementia or MCI
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ED Delirium & Dementia Screening & Outpatient Referral | Rates of Connection With Primary Care | 19 Participants |
Primary
Rates of Outpatient Assessment Referral of Patients With Suspected Dementia
number of patients with appointment to Alzheimer's Dementia Centers or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| ED Delirium & Dementia Screening & Outpatient Referral | Rates of Outpatient Assessment Referral of Patients With Suspected Dementia | 26 Participants |