Background
People with dementia are at increased risk for hospitalization, readmission and mortality due to infections. Timely infection detection and management is essential and is often challenged by the presence of atypical infection signs in people with dementia, difficulties in communicating their symptoms, and inadequate external support. Thus, understanding what takes place in the decision-making processes and interventions of suspected infections is crucial to provide clarity over the best way to deliver the needed interventions.

Objective
To explore the decision-making processes and interventions for detecting and managing suspected infections in people with dementia and involved actors and determinants. The goal was to identify existing practices and knowledge gaps to inform targeted interventions.

Methods
A scoping review was conducted through comprehensive searches of Embase and PubMed 2010-2023, guided by research questions and predetermined inclusion (original qualitative and quantitative articles focusing on people with dementia) and exclusion criteria (palliative and end-of-life care). Two authors independently screened and extracted data and synthesized findings through mapping and narrative analysis.

Results
The search identified 13 933 records and 11 full-text studies were included in the analysis. We additionally included snippets from 10 studies where parts of the findings were related to dementia. Research was mostly based on populations in the United States, followed by Sweden and the United Kingdom. Majority of research was on practices within nursing homes, and mainly concentrating on urinary and respiratory infections.

Decision-making processes were presented in almost two thirds of the studies, with the rest being Interventions targeting healthcare staff and one targeting proxies. Interventions included decision-support tools (computer algorithms, posters), early warning/detection systems or pathways (based on observing behavioral and physical changes in patients), a communication technique, and training/education interventions (seminars, courses, booklets).

Actors involved were dementia patients, nurses, proxies, physicians, physician assistants, and nursing and care assistants.

Conclusions
Overall, we found little attention in research towards infection detection in people with dementia, particularly outside of the nursing homes. Our findings and the highlighted knowledge gaps both inform and encourage further research which will ultimately translate into targeted interventions improving infection detection practices.