What This Means
This research suggests that emergency departments (EDs) are poorly suited for people living with dementia who must stay overnight, particularly because the noisy, brightly lit, and constantly active environment disrupts sleep and may increase the risk of delirium — a state of sudden confusion that can be dangerous for this population. Researchers used a 'co-design' approach, meaning they worked directly with ED nurses, technicians, caregivers of people with dementia, and community advisors to identify the problems and brainstorm solutions together, rather than designing an intervention without input from those affected.
The study found that practical strategies could include dimming lights and reducing noise at night, grouping medical tasks together so patients are disturbed less frequently, establishing familiar bedtime routines, providing 'delirium carts' stocked with non-drug comfort items, and involving family caregivers more actively in nighttime care. However, participants also flagged real-world obstacles, such as limited staffing, insufficient training in dementia care among ED staff, and the need for dedicated staff 'champions' who would take ownership of keeping these practices going. Community advisors particularly emphasized that approaches need to be tailored to individual patients and that caregivers should have a meaningful role in decision-making.
This research matters because people with dementia are a vulnerable group who often spend extended periods in emergency departments waiting for hospital beds, yet very little has been done to adapt the ED environment to their specific needs. The findings lay groundwork for developing and testing a practical sleep intervention in the ED setting, which could potentially reduce delirium, improve patient comfort, and support both patients and their caregivers during a stressful experience.