Clinical impact of geriatric emergency department accreditation (GEDA) on older adults with dementia

About This Grant

The growing number of older Americans who seek care in emergency departments (EDs) has increased awareness of the need for specialized geriatric emergency care. Since 2018, the Geriatric ED Accreditation (GEDA) program has promoted such care, and there now are >500 GEDA EDs, across the 3 levels: Gold (~6%), Silver (~11%), and Bronze (~83%). GEDA is particularly attentive to the care of vulnerable older adults, such as persons living with dementia (PLWD). PLWD are a large and growing population that has been shown to visit the ED more often than their cognitively intact counterparts. Alzheimer’s Disease and Related Dementias (ADRD) are often under-recognized during these ED visits, and PLWD have been shown to experience prolonged ED length-of-stay and avoidable hospitalizations. Over the past two years, members of the study team have performed foundational research on GEDA and now seek to investigate, among PLWD, if ED participation in GEDA leads to better emergency care processes and better clinical outcomes. We propose a mixed methods project that combines three population-based datasets from 2022-2024 (NEDI-USA for ED characteristics, including GEDA level; and HCUP SEDD/SID and Medicare for clinical outcomes), and performs qualitative research on ADRD-related ED care practices. The Aims investigate: (1) GEDA level and documentation of ADRD among PLWD. Clinician recognition of ADRD is a critical first step for improving the care of PLWD, yet our Preliminary Work shows that ~1/3 of ED visits by PLWD lack this coding. Hypothesis 1: Compared to non-GEDA EDs, GEDA Gold/Silver EDs are more likely to code ADRD among PLWD. (2) GEDA level and clinical outcomes among PLWD. Hypothesis 2: Compared to PLWD in non-GEDA EDs, those in GEDA Gold/Silver EDs are less likely to have prolonged ED LOS (8+ hours) and to be hospitalized. (3) Adoption and long-term implementation of GEDA practices that improve emergency care for PLWD. Guided by the Consolidated Framework for Implementation Research, we will conduct in-depth qualitative interviews with a purposive sample of ED physician and nurse leaders, based on GEDA level and key ED characteristics (e.g., annual ED visit volume, urban vs rural). Hypothesis 3a: GEDA EDs that successfully integrate ADRD-related care practices into their workflows demonstrate common organizational, cultural, and leadership characteristics. Hypothesis 3b: Specific factors affect the adoption and long-term implementation of ADRD-related care. This R01 project addresses major knowledge gaps and will advance interventional work, including future trials of ADRD-related ED care practices. The investigators have complementary expertise (e.g., emergency medicine, geriatrics, epidemiology, health services research, mixed methods) and a track record of successful collaboration in an exceptional research environment. Preliminary work confirms feasibility, with >90% power for clinically important associations. This 4-year R01 project advances the scientific priorities of NIA/NIH by developing strategies to improve the emergency care of older adults, especially those with ADRD.