Barriers and facilitators to caring for patients living with dementia in the emergency department: a qualitative study.

Abstract

Purpose: Patients living with dementia are complex and visit the emergency department (ED) more frequently than other populations. There is a knowledge gap regarding challenges in care delivery for these patients from the perspective of interdisciplinary healthcare providers. The aim of this study was to identify the barriers and facilitators to caring for people living with dementia in the ED as perceived by healthcare providers to gain a deeper understanding of current care gaps and inform best care practices.

Methods: Semi-structured interviews were conducted with healthcare providers to understand their experiences in caring for people living with dementia in the ED. Healthcare providers currently employed within in a Calgary zone ED and with experience in caring for people living with dementia in the ED were eligible for participation. The Framework Method based on the Theoretical Domains Framework and the Behavior Change Wheel was used in the analysis to inform change interventions by addressing key factors that influence behavior.

Results: A total of 11 providers participated. Key facilitators to care included collaborative team approaches; collateral information from care partners, EMS, and care homes; geriatric medicine staff; addressing non-medical needs; and person-centered care. Key barriers to care included the ED environment encompassing challenges with lack of resources, staff, and time constraints; deteriorating cognition and behavioral challenges; and a lack of dementia-specific guidance and training.

Conclusion: This study highlights key issues in emergency care delivery at the system, unit, provider, and patient levels for people living with dementia through the analysis of healthcare provider experiences. Environmental context and resources, skills, and social/professional role and identity were key domains correlating to the major barriers and facilitators in these findings. Key opportunities for change are identified through which targeted interventions and policies may address dementia-related care gaps within the ED context.