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Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review
Williamson LE, Evans CJ, Cripps RL, Leniz J, Yorganci E, Sleeman KE.. Journal of the American Medical Directors Association, 2021-07-14
Topic: Risk, prevention and care in population studies
Objectives Emergency department (ED) attendance is common among people with dementia and increases toward the end of life. The aim was to systematically review factors associated with ED attendance among people with dementia approaching the end of life. Design Systematic search of 6 databases (MEDLINE, EMBASE, ASSIA, CINAHL, PsycINFO, and Web of Science) and gray literature. Quantitative studies of any design were eligible. Newcastle-Ottawa Scales and Cochrane risk-of-bias tools assessed study quality. Extracted data were reported narratively, using a theoretical model. Factors were synthesized based on strength of evidence using vote counting (PROSPERO registration: CRD42020193271). Setting and participants Adults with dementia of any subtype and severity, in the last year of life, or in receipt of services indicative of nearness to end of life. Measurements The primary outcome was ED attendance, defined as attending a medical facility that provides 24-hour access to emergency care, with full resuscitation resources. Results After de-duplication, 18,204 titles and abstracts were screened, 367 were selected for full-text review and 23 studies were included. There was high-strength evidence that ethnic minority groups, increasing number of comorbidities, neuropsychiatric symptoms, previous hospital transfers, and rural living were positively associated with ED attendance, whereas higher socioeconomic position, being unmarried, and living in a care home were negatively associated with ED attendance. There was moderate-strength evidence that being a woman and receiving palliative care were negatively associated with ED attendance. There was only low-strength evidence for factors associated with repeat ED attendance. Conclusions and implications The review highlights characteristics that could help identify patients at risk of ED attendance near the end of life and potential service-related factors to reduce risks. Better understanding of the mechanisms by which residential facilities and palliative care are associated with reduced ED attendance is needed.
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APA 7th
Williamson, L. E., Evans, C. J., Cripps, R. L., Leniz, J., Yorganci, E., & Sleeman, K. E. (2021). Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2021.06.012
Vancouver
Williamson LE, Evans CJ, Cripps RL, Leniz J, Yorganci E, Sleeman KE. Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review. Journal of the American Medical Directors Association. 2021. doi:10.1016/j.jamda.2021.06.012. PMID: 34273269.
BibTeX
@article{williamson2021-34273269,
author = {Williamson, L. E. and Evans, C. J. and Cripps, R. L. and Leniz, J. and Yorganci, E. and Sleeman, K. E.},
title = {{Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review}},
journal = {Journal of the American Medical Directors Association},
year = {2021},
doi = {10.1016/j.jamda.2021.06.012},
pmid = {34273269},
url = {https://doi.org/10.1016/j.jamda.2021.06.012}
}
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Key findings
- The aim was to systematically review factors associated with ED attendance among people with dementia approaching the end of life.
- Results After de-duplication, 18,204 titles and abstracts were screened, 367 were selected for full-text review and 23 studies were included.
- There was high-strength evidence that ethnic minority groups, increasing number of comorbidities, neuropsychiatric symptoms, previous hospital transfers, and rural living were positively associated with ED attendance, whereas higher socioeconomic position, being unmarried, and living in a care home were negatively associated with ED attendance.
- There was moderate-strength evidence that being a woman and receiving palliative care were negatively associated with ED attendance.
- There was only low-strength evidence for factors associated with repeat ED attendance.
Study details
- Evidence strengthLow
How this study scored 60/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 35 of the 58 points we could judge it on, which is 60 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Medical Directors Association) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 12 / 12 | A systematic review of all the studies on the question (from PubMed type “Systematic Review”) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | A review of other studies — randomization is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 34273269) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 35 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 35 of the 58 points we could judge it on is 60 out of 100. |
| Total | 60 / 100 | — |
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