Do Systematic Screenings for Dementia in NH Residents Reduce ED Transfers?

For older nursing home (NH) residents, recent study findings failed to show that systematic screening for dementia lowered the number of emergency department transfers. The findings were published online in JAMA Network Open.  

“Dementia is often underdiagnosed in NHs,” wrote Yves Rolland, MD, PhD, and colleagues. “This potentially results in inappropriate care, and high rates of emergency department transfers in particular.”

In order to understand if the combination of systematic dementia screening with multidisciplinary team meetings reduced emergency department transfers, Dr Rolland alongside the research team conducted a multicenter, cluster randomized trial with NHs as the unit of randomization. The research team recruited 64 NHs for the trial and observed 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female). The study participants had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months.

“Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice,” explained Dr Rolland and colleagues.

There were 599 participants in the intervention group from 32 NHs and 829 in the control group, also from 32 NHs.

“The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months,” they continued.

According to the study authors, 1042 residents, or 73.0%, completed the final study visit.

The findings showed that the main reason for early discontinuation was death (318 residents [22.7%]). Additionally, the study authors found that during the 12-month follow-up, ED transfers were not reduced by the intervention, and the percent of residents who were transferred to an ED at least once during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24).

“This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers,” Dr Rolland and colleagues concluded.

“The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers.”

—Julie Gould  

Reference:

Rolland Y, Tavassoli N, de Souto Barreto P, et al. Systematic dementia screening by multidisciplinary team meetings in nursing homes for reducing emergency department transfer [published online February 26, 2020]. JAMA Netw Open. 2020;3(2):e200049. doi:10.1001/jamanetworkopen.2020.0049