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Nitchingham A, Caplan GA. Current Challenges in the Recognition and Management of Delirium Superimposed on Dementia. Neuropsychiatr Dis Treat 2021; 17:1341-1352. [PMID: 33981143 PMCID: PMC8107052 DOI: 10.2147/ndt.s247957] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022] Open
Abstract
Delirium occurring in a patient with preexisting dementia is referred to as delirium superimposed on dementia (DSD). DSD commonly occurs in older hospitalized patients and is associated with worse outcomes, including higher rates of mortality and institutionalization, compared to inpatients with delirium or dementia alone. This narrative review summarizes the screening, diagnosis, management, and pathophysiology of DSD and concludes by highlighting opportunities for future research. Studies were identified via Medline and PsycINFO keyword search, and handsearching reference lists. Conceptually, DSD could be considered an "acute exacerbation" of dementia precipitated by a noxious insult akin to an acute exacerbation of heart failure or acute on chronic renal failure. However, unlike other organ systems, there are no established biomarkers for delirium, so DSD is diagnosed and monitored clinically. Because cognitive dysfunction is common to both delirium and dementia, the diagnosis of DSD can be challenging. Inattention, altered levels of arousal, and motor dysfunction may help distinguish DSD from dementia alone. An informant history suggestive of an acute change in cognition or alertness should be investigated and managed as delirium until proven otherwise. The key management principles include prevention, identifying and treating the underlying precipitant(s), implementing multicomponent interventions to create an ideal environment for brain recovery, preventing complications, managing distress, and monitoring for resolution. Informing and involving family members or caregivers throughout the patient journey are essential because there is significant prognostic uncertainty, including the risk of persistent cognitive and functional decline following DSD and relapse. Furthermore, informal carers can provide significant assistance in management. Emerging evidence demonstrates that increased exposure to delirium is associated with neuronal injury and worse cognitive outcomes although the mechanisms through which this occurs remain unclear. Given the clinical overlap between delirium and dementia, studying shared pathophysiological pathways may uncover diagnostic tests and is an essential step in therapeutic innovation.
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Affiliation(s)
- Anita Nitchingham
- The Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Aged Care, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Gideon A Caplan
- The Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Aged Care, Prince of Wales Hospital, Sydney, NSW, Australia
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Reversible dementia due to vitamin B12 deficiency in a lung cancer patient: Relevance of preoperative evaluation. Palliat Support Care 2021; 19:377-379. [PMID: 33947505 DOI: 10.1017/s1478951521000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive dysfunction has a negative effect on cancer treatment; however, in a cancer setting, specific treatments can restore cognitive function. Such conditions are known as reversible dementia, with one of these being vitamin B12 (VB12) deficiency. However, there have been no reports of VB12 deficiency identified by preoperative evaluation in cancer patients. METHOD We studied a patient who was referred to the Department of Psycho-oncology on suspicion of cognitive decline prior to lung cancer surgery. Preoperative evaluation revealed VB12 deficiency. RESULTS The patient was an 82-year-old woman diagnosed with lung cancer. She also presented with cognitive decline and, therefore, was referred to the Department of Psycho-oncology for preoperative evaluation. The patient scored 19 points on a Mini-Mental State Examination (MMSE), which is indicative of cognitive decline. As the onset of symptoms occurred several months previously and they were subacute, the possibility of reversible dementia was considered. Extensive examination revealed VB12 deficiency, and VB12 replacement therapy normalized the MMSE score to 25 points before surgery. SIGNIFICANCE OF THE RESULTS When cognitive decline is observed in cancer patients, it is necessary to actively evaluate the serum levels of some B vitamins, including VB12.
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Chou MY, Liang CK, Hsu YH, Wang YC, Chu CS, Liao MC, Chiu CF, Chou MH, Chen LK, Lin YT. Developing a predictive model for hospital-associated disability among older patients hospitalized for an acute illness: the HAD-FREE Score. Eur Geriatr Med 2021; 12:963-971. [PMID: 33939170 DOI: 10.1007/s41999-021-00497-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a predictive model to identify hospitalized older patients at risk of functional decline. METHODS This retrospective cohort study recruited participants aged 65 years and over admitted to internal medicine wards of a tertiary medical center in Taiwan during May to October 2017 for developing predictive model (n = 1698) and those admitted during November to December 2017 for validation study (n = 530) of the model. Demographic data, geriatric assessments and hospital conditions (admission route and length of hospital stay) were collected for analysis. RESULTS Overall, of the 1698 participants (mean age 75.8 ± 7.9 years, 60.9% male) enrolled in the development study, 20.1% had functional decline. Results of multivariate logistic regression showed that older age, hearing impairment, history of falls within one year, risk of malnutrition, physical restraint, admission via emergency department and hospital stay ≥ 5 days were independent predictive factors for decline. A scoring system, HAD-FREE Score, constructed from the above predictive factors ranged from 0 to 18 points and ≥ 6 points was chosen as the cut-off point. The area under the receiver operating characteristic analysis was 0.748 (95% confidence interval: 0.720-0.776), the sensitivity was 65.3% and the specificity was 71.3%. Validation of the HAD-FREE Score showed moderate discriminative ability in the validation study. CONCLUSION A HAD-FREE Score developed from seven independent factors could predict functional decline with moderate discriminative ability and good validation. This scoring system can be the basis of an automatic dynamic tracking within the electronic medical record to identify those older patients at risk of functional decline during hospitalization.
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Affiliation(s)
- Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ying-Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
| | - Che-Sheng Chu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan.
| | - Chun-Fang Chiu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Hsiang Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Codling D, Hood C, Bassett P, Smithard D, Crawford MJ. Delirium screening and mortality in patients with dementia admitted to acute hospitals. Aging Ment Health 2021; 25:889-895. [PMID: 32081035 DOI: 10.1080/13607863.2020.1725804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Delirium is associated with increased mortality in older adults. National guidance recommends that all people with dementia who are admitted to hospital are screened for delirium. However, the impact of screening for delirium among inpatients with dementia has not been examined. This study aims to examine this relationship.Methods: Secondary analysis of data from 10,047 patients admitted to 199 hospitals in England and Wales that took part in the third round of the National Audit of Dementia. Multilevel logistic regression was used to examine associations between delirium screening and cognitive testing with inpatient mortality, adjusted for age, gender, diagnosis and hospital site as potential confounders.Results: The mean age of study patients was 84 years (SD = 7.9), 40.1% were male and 82.1% white British. 1285 patients (12.8%) died during their admission to hospital. Overall, 4466 (44.5%) patients were screened for delirium, of whom 2603 (58.6%) screened positive. The odds of mortality were lower in patients who underwent delirium screening (OR 0.84, 95% confidence interval 0.73 to 0.96) and in those receiving cognitive testing (OR 0.74, 95%CI 0.63-0.76).Conclusion: These results suggest that, among people with dementia who are admitted to hospital, screening for delirium and assessment of cognitive functioning may be associated with lower mortality. While we cannot be certain that these associations are causal, the findings support efforts that are being made to increase levels of screening for delirium among people with dementia who are admitted to hospital.
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Affiliation(s)
- David Codling
- South London and Maudsley NHS Foundation Trust, Beckenham, London, UK
| | - Chloe Hood
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | | | - Mike J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.,Centre for Psychiatry, Imperial College, London, UK
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Morioka N, Moriwaki M, Tomio J, Fushimi K, Ogata Y. Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan. PLoS One 2021; 16:e0249364. [PMID: 33886588 PMCID: PMC8061936 DOI: 10.1371/journal.pone.0249364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/17/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. DESIGN AND SETTING Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). PARTICIPANTS A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. METHODS Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. RESULTS Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. CONCLUSIONS Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.
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Affiliation(s)
- Noriko Morioka
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Karrer M, Schnelli A, Zeller A, Mayer H. A systematic review of interventions to improve acute hospital care for people with dementia. Geriatr Nurs 2021; 42:657-673. [PMID: 33823424 DOI: 10.1016/j.gerinurse.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes. The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.
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Affiliation(s)
- Melanie Karrer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland.
| | - Angela Schnelli
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Hanna Mayer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria
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Reynish E, Hapca S, Walesby R, Pusram A, Bu F, Burton JK, Cvoro V, Galloway J, Ebbesen Laidlaw H, Latimer M, McDermott S, Rutherford AC, Wilcock G, Donnan P, Guthrie B. Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.
Objective
This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.
Design
For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.
Data sources
Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.
Results
In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.
Limitations
A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.
Conclusions
Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.
Future work
Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.
Study registration
This study is registered as PROSPERO CRD42015024492.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma Reynish
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Simona Hapca
- School of Medicine, University of Dundee, Dundee, UK
| | - Rebecca Walesby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Angela Pusram
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Feifei Bu
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Jennifer K Burton
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - James Galloway
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | - Marion Latimer
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | | | - Gordon Wilcock
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Peter Donnan
- School of Medicine, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- School of Medicine, University of Dundee, Dundee, UK
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Abstract
OBJECTIVES The aim of this study was to describe neuropsychiatric disorders of geriatric inpatients, to investigate associations of psychopathological symptomatology with clinical variables and to determine its impact on treatment outcome. METHODS From January to April 2018, treatment data of geriatric inpatient records were collected retrospectively. Clinical diagnoses of neuropsychiatric disorders, that is, depression, dementia, and delirium, were identified. Clinical correlations were calculated by χ2-tests and t-tests. Confounding variables for determined correlations were ascertained by analyses of variance. Functional measurements (Barthel Index, Timed Up and Go, Tinetti Test, and De Morton Immobility Index) were assessed at start and end of geriatric inpatient treatment. RESULTS The mean age of the included 280 inpatients was 84 years, 71% were female, and the mean duration of treatment was 19.5 days. Twenty-nine percent of cases suffered from dementia, 27% from depression, and 15% from delirium at the time of geriatric treatment onset. Mentally ill inpatients, in addition, presented with a significantly higher number of comorbidities, compared to the group of mentally healthy inpatients. In contrast to the dementia and the delirium group of inpatients, prescription of analgetics was highest among the mentally healthy inpatients and inpatients with depression. Improvement was observed in each of the defined groups, and significant functional differences between all groups were found. CONCLUSION Neuropsychiatric disorders occur quite often in a geriatric hospital department, especially depression and dementia. Clinical correlations determined in this study suggest a close relationship of mental and somatic disorders in geriatric inpatients. This study further demonstrates that neuropsychiatric disorders in multimorbid, elderly patients do not prevent functional improvement.
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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Downs M, Blighe A, Carpenter R, Feast A, Froggatt K, Gordon S, Hunter R, Jones L, Lago N, McCormack B, Marston L, Nurock S, Panca M, Permain H, Powell C, Rait G, Robinson L, Woodward-Carlton B, Wood J, Young J, Sampson E. A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support.
Objectives
Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted.
Design
A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect.
Setting
Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7).
Participants
We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting.
Intervention
This ran from February to July 2018.
Data sources
Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed.
Results
The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individual-level data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated.
Limitations
The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent.
Conclusion
A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies.
Future work
Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses.
Trial registration
Current Controlled Trials ISRCTN74109734 and ISRCTN86811077.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin Carpenter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sally Gordon
- National Institute for Health Research Clinical Research Network Yorkshire and Humber, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Liz Jones
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Natalia Lago
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Brendan McCormack
- Division of Nursing and Division of Occupational Therapy and Arts Therapies, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Louise Marston
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | | | - Monica Panca
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Helen Permain
- Research Department, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Catherine Powell
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Greta Rait
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - John Wood
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Sampson EL, Feast A, Blighe A, Froggatt K, Hunter R, Marston L, McCormack B, Nurock S, Panca M, Powell C, Rait G, Robinson L, Woodward-Carlton B, Young J, Downs M. Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing-BHiRCH-NH Study). BMJ Open 2020; 10:e040732. [PMID: 33318118 PMCID: PMC7737107 DOI: 10.1136/bmjopen-2020-040732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. DESIGN Pilot cluster randomised controlled trial. SETTING 14 NHs (7 intervention, 7 control) in London and West Yorkshire. PARTICIPANTS NH residents, their family carers and staff. INTERVENTION Complex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) 'Stop and Watch (S&W)' early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators. OUTCOME MEASURES Data on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted. RESULTS We recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm. CONCLUSIONS Recruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted. TRIAL REGISTRATION NUMBER ISRCTN74109734 (https://doi.org/10.1186/ISRCTN74109734). ORIGINAL PROTOCOL: BMJ Open. 2019;9(5):e026510. doi:10.1136/bmjopen-2018-026510.
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Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College, London, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Brendan McCormack
- Divisions of Nursing, Occupational Therapy & Arts Therapies, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Shirley Nurock
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College, London, UK
| | - Monica Panca
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Catherine Powell
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Greta Rait
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford, UK
| | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
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Effects of a Person Centered Dementia Training Program in Greek Hospital Staff-Implementation and Evaluation. Brain Sci 2020; 10:brainsci10120976. [PMID: 33322754 PMCID: PMC7763588 DOI: 10.3390/brainsci10120976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
People with Dementia (PwD) are frequently admitted in general hospitals. However, health care professionals have lack of dementia knowledge, negative attitudes toward dementia, and lack of confidence in caring those patients. The aim of this study is to develop, implement and evaluate a dementia staff training program in Greek general hospitals. It was a repeated-measures research design. Fourteen (14) two-day workshops were conducted, consisting of six targeted and interactive modules. Staff members (N = 242) attended the program and were assessed according to (1) individual performance: questionnaires about attitudes towards dementia, confidence in care, knowledge about dementia and anxiety before, immediately after the training and three months later, (2) an overall training evaluation immediately after the training and (3) an evaluation of training implementation three months later. Positive attitudes towards dementia, improvement of confidence in care and decrease of feeling of anxiety as a trait, were sustained over time. Knowledge about dementia also increased after the training and sustained, with, however, a slight decrease over time. A well applied training program seems to provide the basis of a better care in PwD during hospitalization. However, changes in the organizational level and a transformation of care culture are necessary for training sustainability over time.
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Ghneim M, Diaz JJ. Dementia and the Critically Ill Older Adult. Crit Care Clin 2020; 37:191-203. [PMID: 33190770 DOI: 10.1016/j.ccc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dementia is a terminal illness that leads to progressive cognitive and functional decline. As the elderly population grows, the incidence of dementia in hospitalized older adults increases and is associated with poor short-term and long-term outcomes. Delirium is associated with an accelerated cognitive decline in hospitalized patients with dementia. The first step in the management of dementia is accurate and early diagnosis. Evidence-based management guidelines in the setting of critical illness and dementia are lacking. The cornerstone of management is defining goals of care early in the course of hospitalization and using palliative care and hospice when deemed appropriate.
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Affiliation(s)
- Mira Ghneim
- R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, 22 South Green Street, S4D07, Baltimore, MD 21201, USA.
| | - Jose J Diaz
- R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, 22 South Green Street, S4D07, Baltimore, MD 21201, USA
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Ernst J, Petry H, Luethi N, Naef R. Acute care delivery to persons with cognitive impairment: a mixed method study of health professionals' care provision and associated challenges. Aging Ment Health 2020; 24:1726-1735. [PMID: 31119943 DOI: 10.1080/13607863.2019.1616162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Cognitive impairment is common among older persons admitted to hospital and associated with adverse outcomes. Inadequate care has been widely reported, with health professionals tending to be ill-equipped to meet the specific needs of this patient group. This study aimed to investigate health professionals' care provision to persons with cognitive impairment and associated challenges.Design and Setting: A concurrent, cross-sectional mixed method study was conducted at two university-affiliated hospitals.Participants: A total of 339 health professionals participated in the study.Measurements: An online survey (n = 312) determined the extent to which health professionals perceived their care provision to be person-centered and evidence-based (POPAC-R), and experience distress in looking after this patient group (NPI-D). Four focus group interviews (n = 27) explored health professionals' experience of care provision.Results: More than half of the health professionals reported to act always or very frequently in person-centered and evidence-based ways, and two third experienced challenging behaviors as moderately to very distressing. Health professionals working in acute geriatric wards demonstrated statistically significant higher levels of person-centered and evidence-based care provision, and lower distress. Their caring practices pertained to building a relationship, addressing specific needs, involving family members, and working collaboratively.Conclusions: Findings suggest that geriatric models of care delivery support staff in meeting the needs of persons with cognitive impairment. Health professionals require an acute care culture that values relational, collaborative and coordinated care as essential to patient safety and quality of care, and supports the consistent implementation of evidence-based practices for this patient group.
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Affiliation(s)
- Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Nadja Luethi
- Clinic for Acute Geriatrics, Waid City Hospital, Zurich, Switzerland
| | - Rahel Naef
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Measurement Properties of the CAPACITY Instrument to Assess Perceived Communication With the Health Care Team Among Care Partners of Patients With Cognitive Impairment. Med Care 2020; 58:842-849. [PMID: 32826749 DOI: 10.1097/mlr.0000000000001363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument measures how care partners perceive themselves to be supported by the patient's health care team and their experiences communicating with the team. OBJECTIVES The objective of this study was to assess the measurement properties (ie, structural validity of the construct and internal consistency) of the CAPACITY instrument in care partners of patients with cognitive impairment, and to examine whether care partner health literacy and patient cognitive impairment are associated with a higher or lower CAPACITY score. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS A total of 1746 dyads of community-dwelling care partners and older adults in the United States with cognitive impairment who obtained an amyloid positron emission tomography scan. MEASURES The CAPACITY instrument comprises 12 items that can be combined as a total score or examined as subdomain scores about communication with the team and care partner capacity-assessment by the team. The 2 covariates of primary interest in the regression model are health literacy and level of cognitive impairment of the patient (Modified Telephone Interview Cognitive Status). RESULTS Confirmatory factor analysis showed the CAPACITY items fit the expected 2-factor structure (communication and capacity). Higher cognitive functioning of patients and higher health literacy among care partners was associated with lower communication domain scores, lower capacity domain scores, and lower overall CAPACITY scores. CONCLUSIONS The strong psychometric validity of the CAPACITY measure indicates it could have utility in other family caregivers or care partner studies assessing the quality of interactions with clinical teams. Knowing that CAPACITY differs by care partner health literacy and patient impairment level may help health care teams employ tailored strategies to achieve high-quality care partner interactions.
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Ruangritchankul S, Peel NM, Hanjani LS, Gray LC. Drug related problems in older adults living with dementia. PLoS One 2020; 15:e0236830. [PMID: 32735592 PMCID: PMC7394402 DOI: 10.1371/journal.pone.0236830] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M. Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Mine Y, Muramatsu K, Fushimi K, Matsuda S. Hospitalization and discharge routes of elderly hip fracture patients with and without dementia: a nationwide cross-sectional exploratory study using the Japanese Diagnostic Procedure Combination database. Disabil Rehabil 2020; 44:1268-1274. [PMID: 32730727 DOI: 10.1080/09638288.2020.1800107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The characteristics of elderly hip fracture patients in acute care hospitals were analyzed based on hospitalization and discharge route and the presence or absence of a dementia diagnosis. METHODS The study was conducted as a cross-sectional exploratory study using data from the Diagnosis Procedure Combination database in Japan from April 2014 to March 2016. Patients aged 65 years or older who had surgery for a hip fracture were identified. We subsequently extracted patients whose home, medical institution (including convalescent rehabilitation wards), or elderly care facility was both the admission and discharge route. A total of 105 122 patients were included. RESULTS 19% of patients were diagnosed with dementia. Patients with dementia had a shorter length of acute care hospital stay than those without dementia. The hospitalization route for dementia patients was 51% at home and 40% at a care facility. Dementia patients were discharged to hospital and care facilities at 41% each. Nearly all patients received hospital-based postoperative rehabilitation regardless of dementia but patients with dementia had lower gains in activities of daily living. CONCLUSION Hip fracture patients with dementia have less opportunity for continuous hospital-based rehabilitation and need an environment that allows for continuous elderly care facility-based and community-based rehabilitation.IMPLICATIONS FOR REHABILITATIONIn Japan, an aging society, one in five elderly patients undergoing hip fracture surgery was diagnosed with dementia.Many hip fracture patients with dementia have a shorter length of hospital stay and may have fewer opportunities to change hospitals to receive rehabilitation.It is necessary to establish an ongoing and proactive community- and elderly care facility-based rehabilitation system for patients with hip fracture with dementia after acute care hospital discharge.
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Affiliation(s)
- Yuko Mine
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Secretariat of the Japanese Physical Therapy Association, Tokyo, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Gnanamanickam ES, Dyer SM, Harrison SL, Liu E, Whitehead C, Crotty M. Associations between Cognitive Function, Hospitalizations and Costs in Nursing Homes: A Cross-sectional Study. J Aging Soc Policy 2020; 34:552-567. [PMID: 32600162 DOI: 10.1080/08959420.2020.1777824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In an Australian nursing home population, associations between cognitive function and 12-month hospitalizations and costs were examined. Participants with dementia had 57% fewer hospitalizations compared to those without dementia, with 41% lower mean hospitalization costs; poorer cognition scores were also associated with fewer hospitalizations. The cost per admission for those with dementia was 33% greater due to longer hospital stays (5.5 days versus 3.1 days for no dementia, p = .05). People with dementia were most frequently hospitalized for fractures. These findings have policy implications for increasing investment in accurate and timely diagnosis of dementia and fall and fracture prevention strategies to further reduce associated hospitalization costs.
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Affiliation(s)
- Emmanuel Sumithran Gnanamanickam
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, Adelaide, Australia.,Health Data Science and Clinical Trials, Flinders University, Adelaide, Australia
| | - Suzanne Marie Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Stephanie Lucy Harrison
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Registry of Older South Australians, Health Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Enwu Liu
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Bone Health and Fractures Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
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Fox A, MacAndrew M, Wyles K, Yelland C, Beattie E. Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization. J Appl Gerontol 2020; 40:847-855. [PMID: 32463310 DOI: 10.1177/0733464820924211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The number of patients attending acute care hospitals with a diagnosis of dementia is increasing. The impact of hospitalization on function and adverse events is perceived to be greater for patients with dementia than those without. This study compared adverse events (falls, wounds, delirium, medication errors, infections, and incontinence), functional decline, and allied health therapy for patients with and without dementia (n = 240). Patients with dementia experienced significantly more adverse events and constant observation by staff, were more dependent with mobility, hygiene and feeding, more often nil by mouth, confused, and incontinent. Patients with dementia were significantly more likely to receive speech and physiotherapy, although they did not significantly improve in function during their hospital stay. Conversely, patients without dementia significantly improved in mobility and continence. The unique health care needs of patients with dementia need to inform models of care, policy, and practice to support safe health care delivery in this vulnerable population.
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Affiliation(s)
- Amanda Fox
- Queensland University of Technology, Brisbane, Australia
| | | | - Katy Wyles
- Queensland University of Technology, Brisbane, Australia
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Lagarto L, Albuquerque E, Loureiro D, Vieira F, Esteves P, Neves S, Teixeira-Veríssimo M, Cerejeira J. Arousal changes and delirium in acute medically-ill male older patients with and without dementia: a prospective study during hospitalization. Aging Ment Health 2020; 24:820-827. [PMID: 30595038 DOI: 10.1080/13607863.2018.1548569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Previous research has characterized the prevalence, natural course and outcomes of delirium superimposed in dementia but much less is known about the relation between preexisting dementia and the emergence of altered arousal (such as drowsiness, obtundation, stupor or agitation) during acute medical illness. This study aimed to determine the natural course of delirium and abnormal arousal states in acute medically-ill older patients with and without prior dementia during hospital stay.Methods: Observational prospective study in an acute male geriatric ward. Patients aged ≥ 65 years old were assessed by a psychiatrist within the first 72h of admission and in every other day until discharge to determine the level of arousal and the presence of delirium. Prior cognitive impairment, sociodemographic data, chronic comorbidities, psychotropic prescription and functional status were assessed at baseline.Results: 43.5% of participants in the final sample (n= 269) had dementia. Prior dementia was associated with higher rates of moderate/severe hypoarousal (29.9% vs. 4.6%; p<0.001) and delirium (20.5% vs. 7.2%; p<0.001) at admission. RASS ≤ -3 at admission predicted a 4-fold increased intra-hospital mortality risk and RASS ≠ 0 had a sensitivity of 82.8% and a specificity of85.9% for delirium.Conclusions: Moderate/severe hypoarousal is associated with adverse outcomes and should be assessed as part of delirium spectrum, particularly in subjects with prior dementia.
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Affiliation(s)
- Luísa Lagarto
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisabete Albuquerque
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Diana Loureiro
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Vieira
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Esteves
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Sandra Neves
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Manuel Teixeira-Veríssimo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Deparment of Internal Medicine, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Cerejeira
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Gungabissoon U, Perera G, Galwey NW, Stewart R. The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: the South London and Maudsley case register. BMJ Open 2020; 10:e035779. [PMID: 32284392 PMCID: PMC7200045 DOI: 10.1136/bmjopen-2019-035779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment. SETTING We used data from a large London mental healthcare case register linked to a national hospitalisation database. PARTICIPANTS Individuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography. OUTCOME MEASURES We evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population. RESULTS Of the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis. CONCLUSIONS Individuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions.
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Affiliation(s)
- Usha Gungabissoon
- Epidemiology (Value Evidence and Outcomes), GSK, Brentford, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Sanatinia R, Crawford MJ, Quirk A, Hood C, Gordon F, Crome P, Staniszewska S, Zafarani G, Hammond S, Burns A, Seers K. Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear.
Aims
To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay.
Design
Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia.
Setting
Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit.
Participants
Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia.
Main outcome measures
Length of stay, quality of assessment and carer-rated experience.
Results
People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff.
Limitations
The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia.
Conclusions
If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised.
Future work
Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Mike J Crawford
- Centre for Psychiatry, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Chloe Hood
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Fabiana Gordon
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gemma Zafarani
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sara Hammond
- Centre for Psychiatry, Imperial College London, London, UK
| | - Alistair Burns
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Fox A, MacAndrew M, Ramis MA. Health outcomes of patients with dementia in acute care settings-A systematic review. Int J Older People Nurs 2020; 15:e12315. [PMID: 32207886 DOI: 10.1111/opn.12315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/06/2020] [Accepted: 03/04/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND An ageing population has resulted in increased numbers of people with dementia attending acute care services; however, the impact of hospitalisation on this population is uncertain. PURPOSE This systematic review aimed to synthesise the available evidence on adverse health outcomes for people with dementia in acute care settings. METHODS A systematic search of CINAHL, PubMed, MEDLINE, EMBASE and Scopus databases for primary research articles in English language, published from 2000 to 2017, was conducted. A protocol for the review was registered on the PROSPERO database. RESULTS The initial search identified 5,520 records. Following removal of duplicates and assessment against inclusion criteria, 13 studies were included in the final review. Findings identify associations between patients with dementia, longer length of hospital stay and higher mortality in some situations. Heterogeneity across studies in data reporting and outcomes prevented meta-analysis; therefore, results are presented narratively. CONCLUSIONS Certainty of findings from this review is impacted by variation in patient condition and data reporting. Additional rigorous studies on health outcomes for people with dementia during acute hospitalisation will contribute to the evidence. IMPLICATIONS FOR PRACTICE These findings along with further research examining outcomes for patients with dementia in acute care settings will inform provision of safer, quality care and optimal health outcomes for this vulnerable population.
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Affiliation(s)
- Amanda Fox
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Margaret MacAndrew
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Mary-Anne Ramis
- Evidence in Practice Unit, Queensland Centre for Evidence Based Nursing and Midwifery, Mater Health, South Brisbane, Qld, Australia
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Surr CA, Sass C, Burnley N, Drury M, Smith SJ, Parveen S, Burden S, Oyebode J. Components of impactful dementia training for general hospital staff: a collective case study. Aging Ment Health 2020; 24:511-521. [PMID: 30596270 DOI: 10.1080/13607863.2018.1531382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and objectives: People with dementia occupy around one quarter of general hospital beds, with concerns consistently raised about care quality. Improving workforce knowledge, skills and attitudes is a mechanism for addressing this. However little is known about effective ways of training healthcare staff about dementia. This study aimed to understand models of dementia training most likely to lead to improved practice and better care experiences for people with dementia, and to understand barriers and facilitators to implementation.Method: A collective case study was conducted in three National Health Service Acute Hospital Trusts in England. Multiple data sources were used including interviews with training leads/facilitators, ward managers and staff who had attended training; satisfaction surveys with patients with dementia and/or carers; and observations of care using Dementia Care Mapping.Results: Interactive face-to-face training designed for general hospital staff was valued. Simulation and experiential learning methods were felt to be beneficial by some staff and stressful and distressing by others. Skilled delivery by an experienced and enthusiastic facilitator was identified as important. Staff identified learning and practice changes made following their training. However, observations revealed not all staff had the knowledge, attitudes and skills needed to deliver good care. Patient and carer satisfaction with care was mixed. A major barrier to training implementation was lack of resources. Supportive managers, organisational culture and strong leadership were key facilitators.Conclusion: Dementia training can lead to improved care practices. There are a range of key barriers and facilitators to implementation that must be considered.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Cara Sass
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Natasha Burnley
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Michelle Drury
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sarah J Smith
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Sahdia Parveen
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sarah Burden
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
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75
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Lüdecke D, Kofahl C. [Use of sedating medication and physical restraints for patients with dementia in acute care hospitals : A non-randomized case control study]. Z Gerontol Geriatr 2020; 53:138-144. [PMID: 32048012 PMCID: PMC8279997 DOI: 10.1007/s00391-020-01697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/20/2020] [Indexed: 11/09/2022]
Abstract
Hintergrund Auf Menschen mit Demenz mit stationär behandlungsbedürftiger Akuterkrankung ist der Großteil der Akutkrankenhäuser kaum vorbereitet. Dies birgt die Gefahr der Überforderung für das Personal. Demenzerkrankungen sind der häufigste Grund dafür, dass Krankenhauspersonal sedierende Medikamente verabreicht und bewegungseinschränkende Maßnahmen einsetzt. Zielsetzung Die vorliegende Studie untersucht Faktoren, die den (unangemessenen) Einsatz von sedierenden Medikamenten und bewegungseinschränkenden Maßnahmen beeinflussen. Methoden Eine nichtrandomisierte Fall-Kontroll-Studie wurde in 2 internistischen Abteilungen in Hamburg durchgeführt. In der Interventionsgruppe wurde ein spezielles Versorgungskonzept für Menschen mit Demenz implementiert. Die Versorgungsart in der Kontrollgruppe entsprach der Regelversorgung. Mit logistischen Regressionen wurden Zusammenhänge zwischen Faktoren wie Alter, Demenzschweregrad, Verhaltensauffälligkeiten, Barthel-Index oder Versorgungsart und dem Einsatz sedierender Medikamente bzw. bewegungseinschränkender Maßnahmen untersucht. Ergebnisse Herausfordernde Verhaltensweisen (OR = 1,32) und die Zugehörigkeit zur Kontrollgruppe (OR = 1,94) sind signifikant mit dem Einsatz sedierender Medikamente assoziiert. Ein geringerer Barthel-Index, längere Aufenthaltsdauer und die eine Behandlung in der Kontrollgruppe sind signifikant mit einer höheren Wahrscheinlichkeit des Einsatzes bewegungseinschränkender Maßnahmen assoziiert. Diskussion Der Einsatz sedierender Medikamente als auch bewegungseinschränkender Maßnahmen variiert stark zwischen Interventions- und Kontrollgruppe. Andere Studien, die zu ähnlichen Ergebnissen kommen, sehen verschiedene Bausteine spezieller Versorgungskonzepte als Gründe für diese Unterschiede. Dazu zählen neben der baulichen Gestaltung und räumlichen Aspekten auch demenzspezifische Schulungsangebote und ein angemessener Personalschlüssel. Dies vermag auch Unruhe und herausfordernde Verhaltensweisen aufseiten der Patienten zu reduzieren. Der Verzicht auf Sedierung und bewegungseinschränkende Maßnahmen hat nicht zuletzt auch positive Auswirkungen auf die Lebensqualität von Menschen mit Demenz.
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Affiliation(s)
- Daniel Lüdecke
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Christopher Kofahl
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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76
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Pritchard E, Cussen A, Delafosse V, Swift M, Jolliffe L, Yeates H. Interventions supporting caregiver readiness when caring for patients with dementia following discharge home: A mixed-methods systematic review. Australas J Ageing 2020; 39:e239-e250. [PMID: 31944506 DOI: 10.1111/ajag.12765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore programs and information provided to caregivers of inpatients with dementia to assist with readiness to provide care following discharge. METHODS A mixed-methods systematic review with meta-analysis was conducted. Search terms included dementia, inpatient, caregiver, anxiety, discharge and counselling. RESULTS The search yielded 1938 studies (six databases), 13 met the inclusion criteria. Meta-analysis showed no statistically significant changes in anxiety, depression, burden or quality of life 3 months postintervention. Three emergent qualitative themes for staff consideration are as follows: understanding personal characteristics of both patient and caregiver; presenting an inclusive organisational culture; and providing appropriate information at all stages of admission. A Model of Caregiver Readiness was created from the qualitative results. CONCLUSION The programs did not significantly decrease the outcomes measured. However, caregivers identified that inclusion at all stages during hospital admission was a vital factor to reduce stress and increase caregiver readiness.
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Affiliation(s)
- Elizabeth Pritchard
- Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Amy Cussen
- Occupational Therapy Department, Alfred Health, Caulfield, Victoria, Australia
| | - Veronica Delafosse
- Caulfield Hospital Library Services, Alfred Health, Caulfield, Victoria, Australia
| | - Miriam Swift
- Occupational Therapy Department, Alfred Health, Caulfield, Victoria, Australia
| | - Laura Jolliffe
- Occupational Therapy Department, Alfred Health, Caulfield, Victoria, Australia
| | - Harriet Yeates
- Occupational Therapy Department, Alfred Health, Caulfield, Victoria, Australia.,Occupational Therapy Department, St Vincent's Health, Fitzroy, Victoria, Australia
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Yous ML, Ploeg J, Kaasalainen S, Martin LS. Healthcare professionals' perceptions of P.I.E.C.E.S. education in supporting care delivery for older adults with responsive behaviours of dementia in acute care. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:32-51. [PMID: 30704367 DOI: 10.1080/02701960.2019.1572011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction: In acute care settings persons with dementia often use responsive behaviours such as yelling and hitting as a meaningful mode of communication. Staff dementia care education programs such as P.I.E.C.E.S. may help to address these gaps in care. P.I.E.C.E.S. is a holistic clinical assessment framework that focuses on Physical, Intellectual, and Emotional health, Capabilities of an individual, and the living Environment of a person and the Social being.Aims: The aim of this interpretive descriptive study was to explore the perceptions of healthcare professionals of P.I.E.C.E.S. and recommendations to enhance its uptake.Methods: A total of 15 healthcare professionals from acute medical settings in a hospital in Ontario participated in face-to-face, semi-structured interviews. Experiential thematic and secondary data analyses were performed.Findings: P.I.E.C.E.S. had many positive perceived impacts such as promoting interdisciplinary collaboration. However, participants reported that it was challenging to sustain P.I.E.C.E.S. in practice which led to a tapering off of it approximately one year post-education. A barrier to applying P.I.E.C.E.S. was limited time.Conclusions: Findings indicate the need for educational reinforcements and sustainability strategies for dementia care programs in acute care settings. Organizations should implement regular interdisciplinary meetings to provide opportunities for staff to apply P.I.E.C.E.S.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- School of Nursing, Scientific Director, Aging, Community and Health Research Unit, Faculty of Health Sciences and Associate Member, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | | | - Lori Schindel Martin
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
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Matsuoka T, Taniguchi S, Imai A, Fujimoto H, Narumoto J. Preliminary study of the role of general hospital psychiatric ward for patients with dementia in Japan. Asian J Psychiatr 2020; 47:101837. [PMID: 31665696 DOI: 10.1016/j.ajp.2019.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
A psychiatric ward in a general hospital might be suitable for people with dementia because of the comprehensive medical care available. The aim was to investigate the characteristics of 86 patients with dementia admitted to psychiatric ward in a general hospital. About 40% of the patients were admitted due to a diagnosis of dementia and the need for treatment of a physical disease. The expected roles of psychiatric ward in a general hospital for patients with dementia include the acute care of physical and psychological problems and a differential diagnosis.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | | | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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79
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Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan. Int Psychogeriatr 2020; 32:97-104. [PMID: 31030703 DOI: 10.1017/s1041610219000395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia. DESIGN AND SETTING This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals. PARTICIPANTS The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia. MEASUREMENTS The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected. RESULTS A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups. CONCLUSIONS Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.
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80
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Yous ML, Martin LS, Kaasalainen S, Ploeg J. Low investment non-pharmacological approaches implemented for older people experiencing responsive behaviours of dementia. SAGE Open Nurs 2020; 6:2377960820964620. [PMID: 33415304 PMCID: PMC7774366 DOI: 10.1177/2377960820964620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The acute care setting is not ideal for older people with dementia; responsive behaviours may be triggered when care is delivered within a strange environment by staff with limited knowledge of life history and personal preferences. Responsive behaviours (e.g., yelling, hitting, restlessness) are used by older people with dementia to communicate their needs and concerns. It is unknown whether non-pharmacological approaches used by nurses support the development of a meaningful interpersonal relationship between nurses and older people with dementia. AIMS The aims of this study were to explore: (a) the types of low investment non-pharmacological approaches (e.g., music, social activities) used by nurses caring for older people experiencing responsive behaviours of dementia in acute medical settings and (b) the factors that influence the decisions of these nurses to implement these approaches. METHODS We present a qualitative secondary analysis of data from a primary study using Thorne's interpretive description approach. Interviews were conducted with 11 nurses and four allied health professionals from acute medical settings in Canada. A qualitative secondary data analytic approach was used, specifically analytic expansion, and experiential thematic analysis. FINDINGS egardless of the educational preparation of nurses, the decision to use specific types of low investment non-pharmacological approaches were influenced by the perfunctory development of the interpersonal relationships in acute care hospitals. The factors that led nurses to use limited approaches (e.g., turning on the TV and providing a newspaper) were lack of dementia care education and attending to other acutely ill clients. CONCLUSIONS This study revealed that nurses in acute medical settings require greater practice growth to deliver relational care which is crucial to supporting older people with dementia. Nurses need education and knowledge translation support to use creative low investment non-pharmacological approaches with the intent on upholding the quality of life older people with dementia.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton,
Ontario, Canada
| | - Lori Schindel Martin
- Faculty of Community Services, Daphne Cockwell School
of Nursing, Ryerson University, Toronto, Ontario, Canada
| | | | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing,
McMaster University, Hamilton, Ontario, Canada
- Department of Health, Aging and Society, McMaster
University, Hamilton, Ontario, Canada
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81
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Grey T, Fleming R, Goodenough BJ, Xidous D, Möhler R, O'Neill D. Hospital design for older people with cognitive impairment including dementia and delirium: supporting inpatients and accompanying persons. Hippokratia 2019. [DOI: 10.1002/14651858.cd013482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Grey
- Trinity College Dublin; TrinityHaus, School of Engineering; 16 Westland Row Dublin Leinster Ireland DO2 YY50
| | - Richard Fleming
- University of Wollongong; Dementia Training Australia; Rm. 114, ITAMS Building, Innovation Campus Wollongong NSW Australia 2522
| | - Belinda J Goodenough
- University of Wollongong; Dementia Training Australia; Rm. 114, ITAMS Building, Innovation Campus Wollongong NSW Australia 2522
| | - Dimitra Xidous
- Trinity College Dublin; TrinityHaus, School of Engineering; 16 Westland Row Dublin Leinster Ireland DO2 YY50
| | - Ralph Möhler
- School of Public Health, Bielefeld University; Department of Health Services Research and Nursing Science; Universitätsstrasse 25 Bielefeld Germany 33615
| | - Desmond O'Neill
- Trinity College; Centre for Ageing, Neuroscience and the Humanities; Trinity Centre for Health Sciences, Tallaght Hospital Dublin Ireland 24
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82
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Bridges J, Gould L, Hope J, Schoonhoven L, Griffiths P. The Quality of Interactions Schedule (QuIS) and person-centred care: Concurrent validity in acute hospital settings. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2019; 1:100001. [PMID: 32685928 PMCID: PMC7357818 DOI: 10.1016/j.ijnsa.2019.100001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a lack of consensus on how the practices of health care workers may be assessed and measured in relation to compassion. The Quality of Interactions Schedule (QuIS) is a promising measure that uses independent observers to assess the quality of social interactions between staff and patients in a healthcare context. Further understanding of the relationship between QuIS and constructs such as person-centred care would be helpful to guide its future use in health research. OBJECTIVE This study aimed to assess the validity of QuIS in relation to person-centred care measured using the CARES® Observational Tool (COT™). METHODS 168 nursing staff-patient care interactions on adult inpatient units in two acute care UK National Health Service hospitals were observed and rated using QuIS and COT™. Analyses explored the relationship between summary and individual item COT™ scores and the likelihood of a negative (lower quality) QuIS rating. RESULTS As the degree of person-centred care improved, QuIS negative ratings generally decreased and positive social ratings increased. QuIS-rated negative interactions were associated with an absence of some behaviours, in particular staff approaching patients from the front (relative risk (RR) 3.7), introducing themselves (RR 3.1), smiling and making eye contact (RR 3.4), and involving patients in their care (RR 3.7). CONCLUSION These findings provide further information about the validity of QuIS measurements in healthcare contexts, and the extent to which it can be used to reflect the quality of relational care even for people who are unable to self-report.
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Affiliation(s)
- Jackie Bridges
- School of Health Sciences, University of Southampton, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- National Institute for Health Research CLAHRC Wessex, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
| | - Lisa Gould
- School of Health Sciences, University of Southampton, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- National Institute for Health Research CLAHRC Wessex, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
| | - Joanna Hope
- School of Health Sciences, University of Southampton, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- National Institute for Health Research CLAHRC Wessex, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
| | - Lisette Schoonhoven
- School of Health Sciences, University of Southampton, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- National Institute for Health Research CLAHRC Wessex, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- University Medical Center Utrecht, Julius Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
- National Institute for Health Research CLAHRC Wessex, Building 67, University Road, Highfield Campus, Southampton SO17 1BJ, United Kingdom
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83
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Schnabel EL, Wahl HW, Penger S, Haberstroh J. Communication behavior of cognitively impaired older inpatients : A new setting for validating the CODEM instrument. Z Gerontol Geriatr 2019; 52:264-272. [PMID: 31628612 PMCID: PMC6821670 DOI: 10.1007/s00391-019-01623-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients' well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. MATERIAL AND METHODS Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. RESULTS Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. CONCLUSION CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.
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Affiliation(s)
- Eva-Luisa Schnabel
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Susanne Penger
- Interdisciplinary Ageing Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Julia Haberstroh
- Interdisciplinary Ageing Research, Goethe University Frankfurt, Frankfurt, Germany
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Kamalzadeh L, Moghaddamnia M, Malakouti SK, Rashedi V, Bahrampour S, Sharifi N, Talebi M, Sina F, Shariati B. Prevalence of Dementia Among Older Patients: A Hospital-Based Study in Iran. Am J Alzheimers Dis Other Demen 2019; 34:500-506. [PMID: 31064201 PMCID: PMC10653364 DOI: 10.1177/1533317519848234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia constitutes a public health hazard in developing countries. The aim of this study was to evaluate the prevalence of dementia and its associated factors in older hospitalized patients. METHODS The participants of this cross-sectional study consisted of older patients admitted to medical wards in Rasoul-e Akram hospital in Tehran, Iran. Mini-Mental State Examination, Mini-Cog test, Geriatric Depression Scale, Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, and socioeconomic questionnaires were used. RESULTS A total of 205 elderly inpatients were included. The mean age was 71.33 ± 7.35 years; 63.4% of the participants had normal cognitive function, while 36.6% had some degree of cognitive impairment. There was a statistically significant relationship between gender, age, number of children, and occupation and the prevalence of dementia. CONCLUSION Appropriate cognitive screening of older patients upon admission to hospitals could help identify potential adverse events and enhance the quality of care for patients with comorbid dementia.
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Affiliation(s)
- Leila Kamalzadeh
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Moghaddamnia
- Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sara Bahrampour
- Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Mina Talebi
- Islamic Azad University, West Tehran Branch, Tehran, Iran
| | - Farzad Sina
- Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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85
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Burgstaller M, Saxer S, Mayer H, Zeller A. [The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study]. Pflege 2019; 33:25-33. [PMID: 31656128 DOI: 10.1024/1012-5302/a000708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study Abstract. Introduction: To deal with the complexity of the situation of people with dementia in acute hospitals, it is necessary to develop tailored interventions. In doing so, it is important to consider the perspectives of all relevant persons, including health care teams. AIM The aim of this study was to explore the situation of people with dementia in three Swiss acute hospitals from the perspective of health care teams. METHODS We conducted three focus group interviews with health care teams consisting of medical doctors, nurses and therapists. Data were analysed by means of summarising content analysis according to Mayring. RESULTS A total of 20 health professionals took part. Three main categories were identified: "People with dementia confront the hospital system", "The hospital system fails to meet the needs of people with dementia" and "Necessary changes take place in the hospital system". The results show a lack of intention in the hospital system to address the specific needs of people with dementia. Health care teams feel forced to intensify their teamwork. This occurs unsystematically and with little organisational support. CONCLUSION It seems of paramount importance to systematically support the teams' initiatives for enhanced teamwork in caring for people with dementia. Teamwork should be considered as a key aspect when developing interventions.
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Affiliation(s)
- Melanie Burgstaller
- Institut für Angewandte Pflegewissenschaft IPW-FHS, Fachhochschule St.Gallen.,Institut für Pflegewissenschaft, Universität Wien
| | - Susi Saxer
- Institut für Angewandte Pflegewissenschaft IPW-FHS, Fachhochschule St.Gallen
| | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien
| | - Adelheid Zeller
- Institut für Angewandte Pflegewissenschaft IPW-FHS, Fachhochschule St.Gallen
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86
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Scerri A, Innes A, Scerri C. Person-centered dementia care in acute hospital wards-The influence of staff knowledge and attitudes. Geriatr Nurs 2019; 41:215-221. [PMID: 31630871 DOI: 10.1016/j.gerinurse.2019.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices. A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards. The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices. The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida MSD 2090, Malta.
| | - Anthea Innes
- Faculty of Social Sciences, University of Stirling, Salford Institute for Dementia, University of Salford, Manchester, United Kingdom.
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida MSD 2080, Malta.
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Schneider J, Gkioka M, Papagiannopoulos S, Moraitou D, Metz B, Tsolaki M, Kruse A, Teichmann B. Expectations of nursing personnel and physicians on dementia training : A descriptive survey in general hospitals in Germany and Greece. Z Gerontol Geriatr 2019; 52:249-257. [PMID: 31616977 PMCID: PMC6821659 DOI: 10.1007/s00391-019-01625-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
Background The number of dementia training programs in hospital settings is steadily increasing. The way training sessions are designed influences the way the learning content is implemented in practice. To develop a successful training it is important to meet the needs of the target group; however, not much is known about staff preferences and expectations relevant to future dementia training programs in hospitals in Germany and Greece. Objective The aim of this survey was to explore staff training needs relevant to the topic of dementia, in general hospitals in Germany and Greece. This study analyzed the interests of staff members, preferences and expectations with respect to dementia training. Material and methods This was a descriptive survey based on a 54-item questionnaire conducted with 61 nursing staff, head nurses and physicians (Germany: n = 25, Greece: n = 36) recruited from 5 hospitals (Germany: n = 3, Greece: n = 2). Parts of the questionnaire explored participants’ previous education regarding dementia and their expectations towards future dementia programs. Results Although staff attendance in educative programs was high in the last 5 years for both countries, participation in dementia training programs was low (Germany 24%, Greece 5.5%). Additionally, the great majority of participants were willing to be trained in future dementia training programs (Germany 96%, Greece 100%). Employees from both countries expect increased clinical skills as a result of participation in such training programs. In Greece, staff members hope for better handling of people with dementia, while in Germany, concrete practical advice is preferred. Conclusion There seems to be a strong willingness to participate in further dementia training programs where not only theoretical knowledge is provided but also practical advice. Electronic supplementary material The online version of this article (10.1007/s00391-019-01625-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Schneider
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, Heidelberg, Germany.
| | - Mara Gkioka
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, Heidelberg, Germany. .,School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece.
| | | | - Despina Moraitou
- Lab of Psychology, Section of Experimental & Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Brigitte Metz
- Klinik für Geriatrie und Geriatrisches Zentrum Karlsruhe, Diakonissenkrankenhaus Karlsruhe-Rüppurr, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - Magdalini Tsolaki
- 1st Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece
| | - Andreas Kruse
- Insitute of Gerontology, Heidelberg University, Heidelberg, Germany
| | - Birgit Teichmann
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, Heidelberg, Germany
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Schnabel EL, Wahl HW, Schönstein A, Frey L, Draeger L. Nurses' emotional tone toward older inpatients: Do cognitive impairment and acute hospital setting matter? Eur J Ageing 2019; 17:371-381. [PMID: 32904870 DOI: 10.1007/s10433-019-00531-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The emotional tone of nurses' voice toward residents has been characterized as overly controlling and less person-centered. However, it is unclear whether this critical imbalance also applies to acutely ill older patients, who represent a major subgroup in acute hospitals. We therefore examined nurses' emotional tone in this setting, contrasting care interactions with severely cognitively impaired (CI) versus cognitively unimpaired older patients. Furthermore, we included a general versus a geriatric acute hospital to examine the role of different hospital environments. A mixed-methods design combining audio-recordings with standardized interviews was used. Audio-recorded clips of care interactions between 34 registered nurses (M age = 38.9 years, SD = 12.3 years) and 92 patients (M age = 83.4 years, SD = 6.1 years; 50% with CI) were evaluated by 12 naïve raters (M age = 32.8 years, SD = 9.3 years). Based on their impressions of the vocal qualities, raters judged nurses' emotional tone by an established procedure which allows to differentiate between a person-centered and a controlling tone (Cronbach's α = .98 for both subscales). Overall, findings revealed that nurses used rather person-centered tones. However, nurses' tone was rated as more controlling for CI patients and in the geriatric hospital. When controlling for patients' functional status, both effects lost significance. To our knowledge, this is the first study that examined nurses' emotional tone in the acute hospital setting. Findings suggest that overall functional status of older patients may play a more important role for emotional tone in care interactions than CI and setting differences.
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Affiliation(s)
- Eva-Luisa Schnabel
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Larissa Frey
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Lea Draeger
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
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Blair A, Bateman C, Anderson K. “They take a lot of pressure off us”: Volunteers reducing staff and family care burden and contributing to quality of care for older patients with cognitive impairment in rural hospitals. Australas J Ageing 2019; 38 Suppl 2:34-45. [DOI: 10.1111/ajag.12612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Annaliese Blair
- Aged Care Evaluation UnitSouthern NSW Local Health District Queanbeyan New South Wales Australia
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Catherine Bateman
- Aged Care Evaluation UnitSouthern NSW Local Health District Queanbeyan New South Wales Australia
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Katrina Anderson
- Aged Care Evaluation UnitSouthern NSW Local Health District Queanbeyan New South Wales Australia
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
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Lüdecke D, Poppele G, Klein J, Kofahl C. Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case-control study comparing a regular ward with a special care ward with dementia care concept. BMJ Open 2019; 9:e030743. [PMID: 31494617 PMCID: PMC6731932 DOI: 10.1136/bmjopen-2019-030743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients' QoL. DESIGN A non-randomised, case-control study including two internal medicine wards from hospitals in Hamburg, Germany. SETTING AND PARTICIPANTS In all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept. OUTCOME MEASURES Our main outcome was the QoL (range 0-100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL. RESULTS QoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: -4.9), psychotropic drug use (-4.4) and agitation (-2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7). CONCLUSIONS A special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.
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Affiliation(s)
- Daniel Lüdecke
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Poppele
- Station DAVID, Evangelisches Krankenhaus Alsterdorf, Hamburg, Germany
| | - Jens Klein
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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91
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The acute care experience of older persons with cognitive impairment and their families: A qualitative study. Int J Nurs Stud 2019; 96:44-52. [DOI: 10.1016/j.ijnurstu.2018.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 11/24/2022]
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Camberlin C, Mistiaen P, Beguin C, Van de Voorde C, Van den Heede K. Patients with dementia in hospitals: a nation-wide analysis of administrative data 2010-2014. Eur Geriatr Med 2019; 10:577-583. [PMID: 34652736 DOI: 10.1007/s41999-019-00205-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Considering the limited information available, the aim of the study was to examine the prevalence and characteristics of inpatients with dementia in Belgian general hospitals. METHODS All admissions of inpatients aged at least 40 years with or without dementia were retrieved from the nationwide administrative hospital discharges database for the period 2010-2014. RESULTS Admissions of inpatients aged 40 years or more with dementia have increased to reach 83,017 out of 1,285,593 admissions (6.46%) in general hospitals in 2014, mostly admitted through the emergency department (79.7%) and for another reason than dementia (85.9%). These patients stayed longer [19.2 days, standard deviation (sd) = 23.6, median = 13] than the average length of stay of patients of the same age (7.9 days, sd = 14.1, median = 17). Considering patients aged 75 years or more falling into the 20 most common pathology groups (of patients with dementia), the group with dementia spent 5 days more than the group without dementia. Patients admitted from home spent more time in hospital when they were discharged to a residential care facility than when they returned home (27.2 days versus 15.8 days). The in-hospital mortality was high in the first days of admission. CONCLUSIONS The growing prevalence of patients with dementia in inpatient setting puts a high pressure on the hospital capacity planning and geriatric expertise. Moreover, as patients with dementia should be kept outside hospitals when possible for safety and quality matters, long-term organizational investments are required inside hospital and residential care settings as well as in community care.
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Affiliation(s)
- Cécile Camberlin
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium.
| | - Patriek Mistiaen
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium
| | - Claire Beguin
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Carine Van de Voorde
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium
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Featherstone K, Northcott A, Bridges J. Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences. Int J Nurs Stud 2019; 96:53-60. [DOI: 10.1016/j.ijnurstu.2018.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/30/2018] [Accepted: 12/07/2018] [Indexed: 11/15/2022]
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Hwang AB, Boes S, Nyffeler T, Schuepfer G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PLoS One 2019; 14:e0219569. [PMID: 31344048 PMCID: PMC6657852 DOI: 10.1371/journal.pone.0219569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients. METHODS For this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered. RESULTS Six studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis. DISCUSSION This review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.
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Affiliation(s)
- Aljoscha Benjamin Hwang
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Thomas Nyffeler
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Guido Schuepfer
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Lehmann J, Michalowsky B, Kaczynski A, Thyrian JR, Schenk NS, Esser A, Zwingmann I, Hoffmann W. The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:735-749. [PMID: 29966191 DOI: 10.3233/jad-171128] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with dementia (PwD) are at a high risk of hospitalization. Hospitals are often not adequately equipped for PwD and discharges often come unexpected. Therefore, PwD are at a risk of adverse outcomes. However, information about those outcomes is rare but crucial for the development of preventive strategies. OBJECTIVES To conduct a quantitative systematic review and meta-analyses on the impact of a hospitalization on readmission, institutionalization, and mortality in PwD. To identify factors associated with these outcomes. METHODS PubMed, CENTRAL, and ScienceDirect were searched for studies including terms for dementia, hospital, readmission, institutionalization, and mortality. Relevant were assessed by a quality criteria sheet. Results were summarized in a table. Meta-analysis was conducted with Review Manager 5.3. RESULTS The search yielded 1,108 studies; 20 fulfilled the inclusion criteria and 10 studies were eligible for meta-analyses. The incidence and relative risk (RR) of mortality (RR 1.74 CI95 % 1.50, 2.05) and institutionalization (RR: 2.16 CI95 % 1.31, 3.56) of PwD was significantly higher when compared to people without dementia. Results according to readmission rate were inconsistent. Factors significantly associated with the examined adverse outcomes were severity of dementia, number of medications, and deficits in daily living activities. CONCLUSION Hospitalization of PwD lead to adverse outcomes. An improvement in the identification of and care for PwD in the acute setting as well as in after care in the community setting, especially in the interface between both settings, is required to prevent adverse outcomes in hospitalized PwD.
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de Vries K, Drury-Ruddlesden J, McGill G. Investigation into attitudes towards older people with dementia in acute hospital using the Approaches to Dementia Questionnaire. DEMENTIA 2019; 19:2761-2779. [DOI: 10.1177/1471301219857577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. Methodology A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the ‘Approaches to Dementia Questionnaire’; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Results Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Conclusion Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice.
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Affiliation(s)
- Kay de Vries
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
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Burn AM, Bunn F, Fleming J, Turner D, Fox C, Malyon A, Brayne C. Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service. BMJ Open 2019; 9:e026927. [PMID: 31164367 PMCID: PMC6561413 DOI: 10.1136/bmjopen-2018-026927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Between 2012 and 2017 dementia case finding was routinely carried out on people aged 75 years and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services. This study explored the impact of dementia case finding on older people and their families and on their use of services. DESIGN Thematic content analysis was conducted on qualitative interview data and costs associated with service use were estimated. Measures included the Mini-Mental State Examination, the EuroQol quality of life scale and a modified Client Service Receipt Inventory. SETTING Four counties in the East of England. PARTICIPANTS People aged ≥75 years who had been identified by case finding during an unplanned hospital admission as warranting further investigation of possible dementia and their family carers. RESULTS We carried out 28 interviews, including 19 joint patient-carer(s), 5 patient only and 4 family carer interviews. Most patients and carers were unaware that memory assessments had taken place, with many families not being informed or involved in the process. Participants had a variety of views on memory testing in hospital and had concerns about how hospitals carried out assessments and communicated results. Overall, case finding did not lead to general practitioner (GP) follow-up after discharge home or lead to referral for further investigation. Few services were initiated because of dementia case finding in hospital. CONCLUSIONS This study shows that dementia case finding may not lead to increased GP follow-up or service provision for patients after discharge from hospital. There is a need for a more evidence-based approach to the initiation of mandatory initiatives such as case finding that inevitably consume stretched human and financial resources.
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Affiliation(s)
- Anne-Marie Burn
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - David Turner
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, Norfolk, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, Norfolk, UK
| | - Alexandra Malyon
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
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Sampson EL, Feast A, Blighe A, Froggatt K, Hunter R, Marston L, McCormack B, Nurock S, Panca M, Powell C, Rait G, Robinson L, Woodward-Carlton B, Young J, Downs M. Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): protocol for a pilot cluster randomised trial. BMJ Open 2019; 9:e026510. [PMID: 31133585 PMCID: PMC6538003 DOI: 10.1136/bmjopen-2018-026510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. METHODS AND ANALYSIS Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). ETHICS AND DISSEMINATION Approved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter). TRIAL REGISTRATION NUMBER ISRCTN74109734; Pre-results.
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Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Rachael Hunter
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Louise Marston
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | | | - Shirley Nurock
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Monica Panca
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Catherine Powell
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Greta Rait
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Institute for Health and Society and Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
| | | | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford, UK
| | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
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Casey P, Dārziņš P, Webb-St Mart M, Baldwin C, Riddell K, Johnson C, Cross W. Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi-campus Australian health service. Australas J Ageing 2019; 38:258-266. [PMID: 31087605 DOI: 10.1111/ajag.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To design, test (pilot) and implement a study to estimate the point prevalence of cognitive impairment (CI) and delirium in a multi-site health service. METHODS Clinicians were trained to use the 4 A's Test (4AT) to screen for cognitive impairment and delirium, and the 3-minute Diagnostic Interview for the Confusion Assessment Method (3D-CAM) to detect delirium in those with abnormal 4AT results. Outcomes of interest were as follows: (a) rates of cognitive impairment and delirium and (b) feasibility of the approach measured by participation rate, "direct survey activity" time, cost and surveyor preparation. RESULTS The rates of cognitive impairment and delirium were 43.8% (245/559) and 16.3% (91/559), respectively. 90.5% (563/622) of eligible adult patients from 25 acute and subacute wards were seen. "Direct survey activities" averaged 14 minutes (range 2-45) and cost $11.48 per patient. Training evaluation indicated additional education in the 4AT and 3D-CAM was needed. CONCLUSION Health services could use this streamlined, inexpensive method to estimate the point prevalence of cognitive impairment and delirium.
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Affiliation(s)
- Penelope Casey
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia.,Eastern Health, Box Hill, Victoria, Australia
| | - Pēteris Dārziņš
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia.,Eastern Health, Box Hill, Victoria, Australia
| | | | | | | | - Claire Johnson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia.,Eastern Health, Box Hill, Victoria, Australia
| | - Wendy Cross
- Federation University, Berwick, Victoria, Australia
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Petty S, Dening T, Griffiths A, Coleston DM. Importance of personal and professional experience for hospital staff in person-centred dementia care: a cross-sectional interview study using freelisting in a UK hospital ward. BMJ Open 2019; 9:e025655. [PMID: 31048438 PMCID: PMC6502240 DOI: 10.1136/bmjopen-2018-025655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/23/2018] [Accepted: 01/30/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To detail how hospital staff with differing personal and professional caregiving experiences approach the care of patients with dementia, in order to make practical recommendations for practice. DESIGN Cross-sectional qualitative interviews. SETTING A UK hospital ward providing dementia care. PARTICIPANTS A complete hospital ward staff team, constituting 47 hospital staff from 10 professions. METHODS Hospital staff were asked to list their approaches to emotion-focused care in individual, ethnographic freelisting interviews. Cultural consensus analysis was used to detail variations in approaches to dementia care between staff subgroups. MAIN OUTCOME MEASURES The most salient listed descriptions of care emphasised by staff members with personal experience of dementia caregiving when compared with staff members without such experience, and descriptions from staff newer to the profession compared with staff with more years of professional dementia caregiving experience. RESULTS Subgroups of hospital staff showed different patterns of responses both in how they noticed the emotional distress of patients with dementia, and in prioritised responses that they deemed to work. Hospital staff with professional experience of dementia caregiving and staff with fewer years of professional experience prioritised mutual communication and getting to know each patient. CONCLUSIONS Subgroups of hospital staff with personal caregiving experiences and fewer years of professional care experience were more likely to describe person-centred care as their routine ways of working with patients with dementia. It is recommended that personal experience and the novice curiosity of hospital staff be considered as valuable resources that exist within multidisciplinary staff teams that could enhance staff training to improve the hospital care for patients with dementia.
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Affiliation(s)
- Stephanie Petty
- Specialist Older Adults Psychology, The Retreat, York, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Donna Maria Coleston
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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