I’m sorry for your loss Sarah - she sounds like an incredible woman and accomplished a great deal and positively influenced many lives in too short of a time

9/ @alzassociation.bsky.social @alzheimerssoc.bsky.social @istaart.bsky.social

#emergencydepartment #dementia #Alzheimers #cognitiveimpairment #EndAlz #medsky

8/ Bottom line:
✅ Screening for CI in the ED can work
🚫 Current diagnostic care transitions often break down
📈 Nearly 80% of those who followed up had confirmed CI

Let’s close the gap between detection and diagnosis - the ED can serve as a critical touchpoint.

7/ We see real promise in pairing cognitive screening with EHR automation. Risk models, auto-referrals, and prompts could lighten ED workload and reduce missed diagnoses. Future work should explore AI and EHR-enhanced pathways. We’re just scratching the surface.

6/ What could help?
• Options like home-based evaluations
• Tech support (e.g., EHR-based alerts or automated referral prompts)
• Risk stratification to prioritize patients needing urgent follow-up
• Public health campaigns to reduce stigma and promote follow-up

5/ Why the referral and follow-up rates are suboptimal:
• Dementia stigma—patients/families may avoid referral
• ED teams overwhelmed
• Fragmented systems, no clear outpatient path
• CI may limit follow-up, esp. without care partner
• Unclear who’s responsible for post-discharge follow-up

4/ The problem: despite effective screening and high follow-up yield, most at-risk patients weren’t referred or didn’t follow up. A huge missed opportunity - EDs are often the first touchpoint for undiagnosed CI. Early detection → timely treatment, caregiver support, better outcomes.

3/ Of those 100 referred, only 19 completed an outpatient cognitive evaluation – again a big drop. Among them:
🧠 79% were diagnosed with some form of CI
🧠 63% had probable dementia
💊 Many were prescribed meds for CI, dementia, or depression.

When the ED refers and patients follow-up…it matters.

2/ First, we screened 9,359 older adults in the ED for memory/thinking problems. ~5% of patients and 33% of care partners flagged possible CI – 650 in total were eligible for referral. Yet only 100 were actually referred. That’s a big drop – we’ll get to potential reasons for this in a bit.

6/ This work is directly responsive to efforts from the multidisciplinary Geriatric Emergency care Applied Research (GEAR) network:

gearnetwork.org
pubmed.ncbi.nlm.nih.gov/34328674/

5/ 🏥 By providing insights into patients' perspectives on ED discharge and follow-up care, PROM-OTED can help health providers improve discharge processes and allow researchers to measure what matters to patients in future studies.

4/ ⏱️ With a mean completion time of just 5 minutes, the PROM-OTED tool can be administered via phone or electronically—making it feasible for diverse patient populations.

#GeriatricEmergencyMedicine #GeriEM #EmergencyMedicine #CareTransitions

3/ ✅ The final 18-item PROM-OTED tool measures critical aspects like understanding discharge instructions, medication management, follow-up care, and quality of life. It’s validated with excellent reliability and a robust factor structure.

2/ 🧑‍🔬 Our study involved 290 older adults (65+) discharged from EDs over 3 years, using qualitative interviews, item generation, and psychometric testing to create a reliable measure of care transition outcomes post-ED discharge. #PatientReportedOutcomes #EDCare

#alzsky #dementia #alzheimer #alzheimers #alz #sciencesky

10/ The big takeaway? Dementia care programs aren’t failing—they’re evolving. We must refine, target, & implement them better. GUIDE is an opportunity to learn from research & build a more effective, scalable system. Let’s get it right. 🚀🧠