A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting.

INTRODUCTION: The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research. METHODS: We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department-based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting. RESULTS: After duplicates were removed, 3277 citations remained and 883 full-text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non-English primary languages. CONCLUSION: Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non-English primary languages.

Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments.

Objectives: Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences of implementing geriatric care processes in EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These EDs can provide a model for adopting and sustaining guidelines for evidence-based geriatric care. Methods: We performed qualitative interviews with geriatric ED nurse and physician leaders overseeing their ED's geriatric accreditation processes. The interview guide was based on the Consolidated Framework for Implementation Research (CFIR), a framework consisting of a comprehensive set of factors that impact implementation of evidence-based interventions. We used inductive analysis to elucidate key themes from interviews and deductive analysis to map themes onto CFIR constructs. Results: Clinician leaders from 15 of 19 EDs that upgraded accreditation status by March 1, 2023 participated in interviews. Motivations to upgrade accreditation level centered on improving patient care (73%) and achieving recognition (56%). Rationales for choosing specific care processes were more commonly related to feasibility (40%) and ability to integrate the processes into the electronic health record (33%) than to site-specific patient needs (20%). Several common experiences in implementation were identified: (1) financing from the larger health system or philanthropy was crucial; (2) translating the Geriatric ED Guidelines into clinical practice was challenging for clinician leaders; (3) motivational barriers existed among frontline ED staff; (4) longitudinal staff education was needed given frontline ED staff attrition and turnover; and (5) the electronic health record facilitated implementation of geriatric screenings. Conclusions: Geriatric ED accreditation involves significant time, resource allocation, and longitudinal staff commitment. EDs pursuing geriatric accreditation balance aspirations to improve patient care with resource availability to implement new care processes and competing priorities.

Perceptions of Acute Care Telemedicine Among Caregivers for Persons Living with Dementia: A Qualitative Study.

Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication and digital literacy challenges. People from racial/ethnic minority groups reported lower comfort with the virtual format. In both sites, participants expressed uncertainty about illness severity that could preclude using telemedicine for acute complaints. Overall, respondents deemed acute care telemedicine acceptable, but caregivers describe specific roles as crucial intermediaries to facilitate virtual care.