Unplanned, urgent and emergency care: what are the roles EMS provide for older people with dementia? An integrative review of policy, professional recommendations and evidence

Abstract

Objective: To synthesise the existing literature on the roles emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie. Design: An integrative review synthesised reports, briefings, professional recommendations and evidence. English language articles were included if they made any reference to the role of EMS in the urgent or emergency care of OPWD. Preparatory scoping and qualitative work with frontline ambulance and primary care staff and carers of OPWD informed our review question and subsequent synthesis Results: Seventeen literature sources were included. Over half were from the grey literature. There was no research that directly addressed the review question. There was evidence in reports, briefings and professional recommendations of EMS addressing some of the issues they face in caring for OPWD. Three roles of EMS could be drawn out of the literature, emergency transport, assess and manage and a ‘last resort’ or safety net role. Conclusions: The use of EMS by older people with dementia is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role EMS play, particularly if considering crises, urgent care responses, and transitions between care settings. EMS research into new ways of working, training or extended paramedic roles should consider specific needs and challenges of responding to people with dementia.