Study: Interventions, training could reduce ED visits for residents with dementia

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Targeted interventions and falls prevention training could help reduce hospital emergency department visits among assisted living residents who have dementia, according to the authors of a small study published in the January–February issue of Geriatric Nursing.

Researchers, Tara J. Sharpp, Ph.D., RN, of California State University, Sacramento, and Heather M. Young, Ph.D., RN, associate vice chancellor for nursing at the University of California, Davis, and dean and professor at the university's Betty Irene Moore School of Nursing, interviewed 14 staff members and nine family members of 71 residents of two specialized dementia units of large, chain-affiliated assisted living communities in northern California. They also reviewed community incident reports from which demographic and personally identifying information had been removed.

Over the six months of the study, 207 incidents occurred, with 77 of them (37%) including a transfer to the ED by ambulance. Eight residents were responsible for 47% of ED visits. The authors, therefore, recommend targeted interventions focused on the heaviest users of ED services to decrease overall transfers and potentially reduce costs.

Of the 207 incidents that occurred; 133 (64%) were falls. Five residents accounted for 36% of the falls. Of the 77 ED transfers, 45 (58%) were because of falls.

Seven of the 133 falls (5%) resulted in serious injury, but 88 of the 133 falls (66%) did not require an ED transfer, and 37 of the 45 falls that did require an ED transfer (82%) resulted in no treatment being provided and no changes to the residents' care.

The assisted living supervisors told researchers they were frustrated that they could not decrease the numbers of falls and transfers to the ED. RN consultation and focused training to assess those who fall might be helpful, the authors write.

Assisted living communities in California are not required to employ RNs, and the training of care staff is minimal compared with the training of skilled nursing care staff, according to the authors. In 2015, the state required direct care staff members to undergo 10 hours of education initially and four hours annually. Workers in specialized dementia units were mandated to undergo an additional six hours of education initially and an additional eight hours annually, the authors say.

“Although it is beyond the scope of the present study, one must question whether a more concerted level of assessment, planning and intervention, initiated by an educated professional such as a gerontological specialist or registered nurse, might be more effective in identifying risk factors and initiating prevention strategies,” they say.

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