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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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Mudge AM, Young A, McRae P, Graham F, Whiting E, Hubbard RE. Qualitative analysis of challenges and enablers to providing age friendly hospital care in an Australian health system. BMC Geriatr 2021; 21:147. [PMID: 33639854 PMCID: PMC7913259 DOI: 10.1186/s12877-021-02098-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system. METHODS In this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines. RESULTS Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce. CONCLUSIONS Progress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.
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Affiliation(s)
- Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,University of Queensland School of Clinical Medicine, Brisbane, Australia.
| | - Adrienne Young
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Prue McRae
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Frederick Graham
- Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia
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Abley C. Developing a dementia care leaders' toolkit for older patients with cognitive impairment. Nurs Older People 2021; 33:14-19. [PMID: 32851821 DOI: 10.7748/nop.2020.e1250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
A recent review of the progress that has been made in meeting the government's Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The review also identified the need for improvements in assessing the individual needs of people with dementia while in hospital, including their emotional and social needs. This article focuses on the development and implementation of an evidence-based toolkit to improve the hospital care of older patients with cognitive impairment, including dementia and/or delirium. The toolkit's focus is on optimising the patient experience of people with cognitive impairment who have been admitted to hospital. The toolkit also promotes the importance of person-centred care and communication skills.
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Affiliation(s)
- Clare Abley
- vulnerable older adults and associate clinical researcher, The Newcastle upon Tyne Hospitals NHS Foundation Trust; honorary clinical senior lecturer, Newcastle University, Newcastle upon Tyne, England
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54
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Keuning-Plantinga A, Finnema EJ, Krijnen W, Edvardsson D, Roodbol PF. Validation and psychometric evaluation of the Dutch person-centred care of older people with cognitive impairment in acute care (POPAC) scale. BMC Health Serv Res 2021; 21:59. [PMID: 33435963 PMCID: PMC7805135 DOI: 10.1186/s12913-020-06048-x] [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: 01/29/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Person-centred care is the preferred model for caring for people with dementia. Knowledge of the level of person-centred care is essential for improving the quality of care for patients with dementia. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale is a tool to determine the level of person-centred care. This study aimed to translate and validate the Dutch POPAC scale and evaluate its psychometric properties to enable international comparison of data and outcomes. Methods After double-blinded forward and backward translations, a total of 159 nurses recruited from six hospitals (n=114) and via social media (n=45) completed the POPAC scale. By performing confirmatory factor analysis, construct validity was tested. Cronbach’s alpha scale was utilized to establish internal consistency. Results The confirmatory factor analysis showed that the comparative fit index (0.89) was slightly lower than 0.9. The root mean square error of approximation (0.075, p=0.012, CI 0.057–0.092) and the standardized root mean square residual (0.063) were acceptable, with values less than 0.08. The findings revealed a three-dimensional structure. The factor loadings (0.69–0.77) indicated the items to be strongly associated with their respective factors. The results also indicated that deleting Item 5 improved the Cronbach’s alpha of the instrument as well as of the subscale ‘using cognitive assessments and care interventions’. Instead of deleting this item, we suggest rephrasing it into a positively worded item. Conclusions Our findings suggest that the Dutch POPAC scale is sufficiently valid and reliable and can be utilized for assessing person-centred care in acute care hospitals. The study enables nurses to interpret and compare person-centred care levels in wards and hospital levels nationally and internationally. The results form an important basis for improving the quality of care and nurse-sensitive outcomes, such as preventing complications and hospital stay length. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06048-x.
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Affiliation(s)
- Annette Keuning-Plantinga
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands. .,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands. .,University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelyn J Finnema
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands.,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands.,Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - Wim Krijnen
- Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Level 4, Austin Tower, PO BOX 55555, Heidelberg, Victoria, 3084, Australia.,Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Petrie F Roodbol
- Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
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"EduKation demenz® Nursing" in the acute hospital setting : Evaluation of a dementia training program: a pilot study. Z Gerontol Geriatr 2021; 54:659-666. [PMID: 33433665 DOI: 10.1007/s00391-020-01838-8] [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] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND An increasing number of people with dementia (PwD) are being hospitalized due to acute conditions. The surrounding conditions and procedures in acute hospitals are not oriented to the special needs of this vulnerable patient group. The behavior of PwD poses particular challenges and burdens for nursing staff. OBJECTIVE The aim of this pilot study was to evaluate the effectiveness of a 2-day dementia training program with a self-reflection component compared to a standard 1.5‑h training of nursing staff caring for PwD in acute hospitals. METHODS A nonrandomized pretest-posttest study with a control group was conducted in three German acute hospitals. Through a questionnaire, nursing staff caring for PwD were examined for potential changes in attitude, strain and confidence levels. The intervention group (n = 32) received a 2-day training program, "EduKation demenz® Nursing", the control group (n = 36) participated in a short,1.5‑h dementia training. RESULTS Compared to the control group, the intervention group demonstrated statistically significant improvement in perceived strain (p = 0.007) and in confidence in caring for PwD (p < 0.001). There were positive but not significant changes in attitude (p = 0.176). CONCLUSION "EduKation demenz® Nursing", a 2-day training program with a self-reflection component, could provide more effective support for nursing staff in acute hospitals caring for PwD than a 1.5‑h training. Results indicate, however, that general conditions in acute hospitals should be changed to allow nursing staff to apply the knowledge gained.
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Aldridge Z, Oliver E, Gardener H, Dening KH. Admiral Nursing-A Model of Specialist Dementia Care in Acute Hospitals. SAGE Open Nurs 2021; 6:2377960820952677. [PMID: 33415301 PMCID: PMC7774376 DOI: 10.1177/2377960820952677] [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: 01/02/2020] [Revised: 01/26/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The rising prevalence of dementia has led to increased numbers of people with
dementia being admitted to acute hospitals. This demand is set to continue
due to an increasingly older population who are likely to have higher levels
of dependency, dementia, and comorbidity. If admitted to the hospital,
people with dementia are at higher risk of poor outcomes during and
following a hospital admission. Yet, there remains a significant lack of
specialist support within acute hospitals to support people with dementia,
their families and hospital staff. Methods Admiral Nurses are specialists that work with families affected by dementia
and provide consultancy and support to health and social care colleagues to
improve the delivery of evidenced based dementia care. Historically, Admiral
Nurses have predominantly been based in community settings. In response to
the increasing fragmentation of services across the dementia trajectory, the
Admiral Nurse model is evolving and adapting to meet the complex needs of
families impacted upon by dementia inclusive of acute hospital care. Results The Admiral Nurse acute hospital model provides specialist interventions
which improve staff confidence and competence and enables positive change by
improving skills and knowledge in the provision of person-centred dementia
care. The role has the capacity to address some of the barriers to
delivering person centred dementia care in the acute hospital and contribute
to improvements across the hospital both as a result of direct interventions
or influencing the practice of others. Conclusion Improving services for people with dementia and their families requires a
whole system approach to enable care coordination and service integration,
this must include acute hospital care. The increasing numbers of people with
dementia in hospitals, and the detrimental effects of admission, make
providing equitable, consistent, safe, quality care and support to people
with dementia and their families a national priority requiring immediate
investment. The inclusion of Admiral Nursing within acute hospital services
supports service and quality improvement which positively impacts upon the
experience and outcomes for families affected by dementia.
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Affiliation(s)
- Zena Aldridge
- Dementia UK, London, UK.,Health and Life Sciences, De Montfort University, Leicester, UK
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Petty S, Griffiths A, Coleston DM, Dening T. Improving emotional well-being for hospital-based patients with dementia. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-05-2020-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting.
Design/methodology/approach
A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis.
Findings
Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes.
Research limitations/implications
The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research.
Originality/value
In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.
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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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Eymundsdottir H, Chang M, Geirsdottir OG, Gudmundsson LS, Jonsson PV, Gudnason V, Launer L, Jonsdottir MK, Ramel A. Lifestyle and 25-hydroxy-vitamin D among community-dwelling old adults with dementia, mild cognitive impairment, or normal cognitive function. Aging Clin Exp Res 2020; 32:2649-2656. [PMID: 32248358 DOI: 10.1007/s40520-020-01531-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Several studies have indicated that older adults with cognitive impairment have a poorer lifestyle than their healthy peers including lower 25-hydroxy-vitamin D levels (25OHD). AIM To investigate the associations between lifestyle and 25OHD depending on cognitive status among old adults. METHODS Community-dwelling old adults (65-96 years) participated in this cross-sectional study based on the Age-Gene/Environment-Susceptibility-Reykjavik-Study. The analytical sample included 5162 subjects who were stratified by cognitive status, i.e., dementia (n = 307), mild cognitive impairment (MCI, n = 492), and normal cognitive status (NCS, n = 4363). Lifestyle variables were assessed and 25OHD was measured. The associations between lifestyle and 25OHD were calculated using linear models correcting for potential confounders. RESULTS According to linear regression models, 25OHD was significantly lower in older people with dementia (53.8 ± 19.6 nmol/L) than in NCS participants (57.6 ± 17.7 nmol/L). Cod liver oil (7.1-9.2 nmol/L, P < 0.001) and dietary supplements (4.4-11.5 nmol/L, P < 0.001) were associated with higher 25OHD in all three groups. However, physical activity ≥ 3 h/week (2.82 nmol/L, P < 0.001), BMI < 30 kg/m2 (5.2 nmol/L, P < 0.001), non-smoking (4.8 nmol/L, P < 0.001), alcohol consumption (2.7 nmol/L, P < 0.001), and fatty fish consumption ≥ 3x/week (2.6 nmol/L, P < 0.001) were related to higher 25OHD in NCS only, but not in participants with dementia or MCI. DISCUSSION Older people living in Iceland with dementia are at higher risk for 25OHD deficiency when compared to healthy individuals. Physical activity reported among participants with dementia, and MCI is low and is not significantly associated with 25OHD. CONCLUSIONS Lifestyle factors among NCS participants are associated with 25OHD levels. Importantly, healthy lifestyle should be promoted among individuals with MCI and dementia.
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Affiliation(s)
- Hrafnhildur Eymundsdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavík, Iceland.
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Tungata 26, 101, Reykjavík, Iceland.
| | - M Chang
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Tungata 26, 101, Reykjavík, Iceland
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Reykjavík, Iceland
| | - O G Geirsdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavík, Iceland
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Tungata 26, 101, Reykjavík, Iceland
| | - L S Gudmundsson
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - P V Jonsson
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Tungata 26, 101, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Geriatrics, The National University Hospital of Iceland, Reykjavík, Iceland
| | - V Gudnason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Icelandic Heart Association, Kópavogur, Iceland
| | - L Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health (NIH), Bethesda, MD, USA
| | - M K Jonsdottir
- Department of Psychology, Reykjavik University, Reykjavík, Iceland
- Mental Health Services (Memory Clinic) Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - A Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavík, Iceland
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Tungata 26, 101, Reykjavík, Iceland
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Design and evaluation protocol for 'DEALTS 2': a simulation-based dementia education intervention for acute care settings. Int Psychogeriatr 2020; 32:1439-1448. [PMID: 30604660 DOI: 10.1017/s1041610218002193] [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: 11/07/2022]
Abstract
BACKGROUND There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate 'DEALTS 2', a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England. METHODS Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process. EVALUATION DESIGN Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train. CONCLUSIONS Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.
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Abrams R, Park S, Wong G, Rastogi J, Boylan AM, Tierney S, Petrova M, Dawson S, Roberts N. Lost in reviews: Looking for the involvement of stakeholders, patients, public and other non-researcher contributors in realist reviews. Res Synth Methods 2020; 12:239-247. [PMID: 32985074 DOI: 10.1002/jrsm.1459] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022]
Abstract
The involvement of non-researcher contributors (eg, stakeholders, patients and the public, decision and policy makers, experts, lay contributors) has taken a variety of forms within evidence syntheses. Realist reviews are a form of evidence synthesis that involves non-researcher contributors yet this practice has received little attention. In particular, the role of patient and public involvement (PPI) has not been clearly documented. This review of reviews describes the ways in which contributor involvement, including PPI, is documented within healthcare realist reviews published over the last five years. A total of 448 papers published between 2014 and 2019 were screened, yielding 71 full-text papers included in this review. Statements about contributor involvement were synthesized across each review using framework analysis. Three themes are described in this article including nomenclature, nature of involvement, and reporting impact. Papers indicate that contributor involvement in realist reviews refers to stakeholders, experts, or advisory groups (ie, professionals, clinicians, or academics). Patients and the public are occasionally subsumed into these groups and in doing so, the nature and impact of their involvement become challenging to identify and at times, is lost completely. Our review findings indicate a need for the realist review community to develop guidance to support researchers in their future collaboration with contributors, including patients and the public.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, England
| | - Sophie Park
- Department of Primary care and population health, UCL, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Juhi Rastogi
- Department of Primary care and population health, UCL, London, UK
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mila Petrova
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
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Lien HNH, Koh EJ, Yap PLK. Understanding the Obstacles to Uptake of Intervention Programmes and Services for Persons with Dementia. Curr Alzheimer Res 2020; 17:526-533. [PMID: 32851947 DOI: 10.2174/1567205017666200807192634] [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] [Received: 03/02/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Utilisation of intervention programmes and services for Persons with Dementia (PWD) has been generally modest despite the growing numbers. One reason has been the lack of knowledge about dementia and information on such services. OBJECTIVE We sought to close this gap by providing caregivers with an information session about dementia and the importance and availability of related services. We explored the uptake of intervention programmes and services and reasons for non-uptake thereafter. METHODS Two hundred and seventy-five PWD and caregiver dyads attended the Dyad Education and Empowerment Programme (DEEP). At the DEEP, while caregivers underwent an information session, PWD were assessed by a multidisciplinary team on their need and suitability for programmes and services such as daycare, cognitive engagement programmes and physical rehabilitation. The dyads then received individualized recommendations on the appropriate services, if any. Follow-up through medical records review and phone calls was conducted one month after DEEP to ascertain if the dyads had acted upon the recommendations and if not, what difficulties they encountered. RESULTS One hundred and eleven PWD received recommendations, of which 40 (36.0%) agreed and enrolled in the services while 71 (64%) declined. Thematic analysis of the reasons for non-uptake revealed 3 themes: PWD-related factors (e.g., refusal, functional improvement or decline), caregiverrelated factors (adequacy of care at home, other care arrangements), and service-related factors (e.g., cost, timing). CONCLUSION Despite adequate information, there are other reasons for non-uptake of dementia- related services, some of which should be addressed to improve service updates and to provide better care for PWD.
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Affiliation(s)
- Ha N H Lien
- Geriatric Education and Research Institute, Singapore, 2 Yishun Central 2, S768024, Singapore
| | - Emily J Koh
- Geriatric Education and Research Institute, Singapore, 2 Yishun Central 2, S768024, Singapore
| | - Philip L K Yap
- Geriatric Education and Research Institute, Singapore, 2 Yishun Central 2, S768024, Singapore
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63
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Novak LS, Horne E, Brackett JR, Meyer K, Ajtai RM. Dementia-Friendly Communities: a Review of Current Literature and Reflections on Implementation. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00325-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396:413-446. [PMID: 32738937 PMCID: PMC7392084 DOI: 10.1016/s0140-6736(20)30367-6] [Citation(s) in RCA: 4738] [Impact Index Per Article: 1184.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - David Ames
- National Ageing Research Institute and Academic Unit for Psychiatry of Old Age, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Sube Banerjee
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Alistair Burns
- Department of Old Age Psychiatry, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Nick Fox
- Dementia Research Centre, UK Dementia Research Institute, University College London, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Division of Psychiatry, University College London, London, UK; Barnet, Enfield, and Haringey Mental Health Trust, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MA, USA
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Casafont C, Risco E, Piazuelo M, Ancín-Pagoto M, Cobo-Sánchez JL, Solís-Muñoz M, Zabalegui A. Care of older people with Cognitive Impairment or Dementia Hospitalized in Traumatology Units (CARExDEM): a quasi-experiment. BMC Geriatr 2020; 20:246. [PMID: 32677894 PMCID: PMC7367239 DOI: 10.1186/s12877-020-01633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia. METHODS A quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia. DISCUSSION Our aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes. TRIAL REGISTRATION Registered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/ Protocol Record HCB/2017/0499. SPONSOR Hospital Clinic Barcelona.
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Affiliation(s)
- Claudia Casafont
- Consultant Nurse in Research, Hospital Clinic Barcelona, Assistant lecturer Universitat de Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - Ester Risco
- Associate Nursing Director. Hospital d’Atenció Intermèdia Parc Sanitari Pere Virgili, Esteve Terrades,30, 08023 Barcelona, Spain
| | - Mercè Piazuelo
- Nurse Unit Manager in Traumatology Unit, Hospital Clinic Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - Marta Ancín-Pagoto
- Vice director of Nursing Care in Complejo Hospitalario de Navarra, Pabellón G. Irunlarrea,3, 31008 Pamplona, Spain
| | - José Luis Cobo-Sánchez
- Consultant Nurse in Research, Hospital Universitario Marqués de Valdecilla, Santander. Pabellón 16 Planta baja. Avenida Valdecilla s/n., 39008 Santander, Spain
| | - Montserrat Solís-Muñoz
- Head of the Care Research Unit, Puerta de Hierro Majadahonda University Hospital. Head of the Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute, Joaquín Rodrigo, 2, 28222 Madrid, Majadahonda Spain
| | - Adelaida Zabalegui
- Vice director of Research and Education in Nursing in Hospital Clinic Barcelona, Assistant lecturer Universitat de Barcelona, Escala 1 planta 7. Villarroel 170, 08036 Barcelona, Spain
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Kakongi N, Rukundo GZ, Gelaye B, Wakida EK, Obua C, Okello ES. Exploring pathways to Hospital Care for Patients with Alzheimer's disease and related dementias in rural South Western Uganda. BMC Health Serv Res 2020; 20:498. [PMID: 32493309 PMCID: PMC7268702 DOI: 10.1186/s12913-020-05365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer's disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. METHODS Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of older adults diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS. Ti software. RESULTS There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers' shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship. CONCLUSIONS Our study findings indicate that caregivers/families of patients with dementia went to different places both formal and informal care settings while seeking health care. However, hospital point of care was more frequent at initial health care visits while places of worship took the lead at subsequent visits. Although no specific pathway reported, most of them begin with hospital (formal) and end with non-formal. We recommend that health systems carry out public awareness on dementia.
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Affiliation(s)
- Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Edith K. Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Grealish L, Bloomer MJ. Editorial: Language and culture: Nurses positioned to lead hospital care for people living with dementia. Collegian 2020. [DOI: 10.1016/j.colegn.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Palm R, Hochmuth A. What works, for whom and under what circumstances? Using realist methodology to evaluate complex interventions in nursing: A scoping review. Int J Nurs Stud 2020; 109:103601. [PMID: 32590248 DOI: 10.1016/j.ijnurstu.2020.103601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Medical Research Council's (MRC) framework recommends basing every evaluation of a complex intervention on a theory that explains WHY an intervention works instead of focusing exclusively on the identification IF an intervention works. Theory-based evaluation approaches such as realist evaluations are promising in this respect. The aim of this scoping review is to examine current scientific literature with regard to the use of realist methodology in studies that evaluate complex nursing interventions. We also seek to answer the question whether realist evaluation studies of complex nursing interventions are embedded in the Medical Research Council's framework. METHODS A systematic database search in MEDLINE and CINAHL supplemented with snowballing techniques and a hand search in relevant nursing journals were performed between January and February 2018 and updated in July 2019. Both authors independently screened the title / abstract of studies that were initially identified and appraised the full texts if inclusion criteria were fulfilled. Inclusion criteria were the explicit use of realist methodology and a focus on the development or evaluation of complex nursing interventions. Results were summarized narratively. RESULTS A total of 28 articles from 22 studies, published between 2010 and 2019, were included. The majority of the studies included originate in the UK. Realist methodology was used by a variety of nursing disciplines, including midwifery, community / public health, critical care, palliative care, gerontological nursing, psychiatric nursing / mental health, and infection control. Study designs included case studies and realist reviews; two studies were conducted alongside a randomized controlled trial. All studies included used more than one method to develop their results; the majority of methods were qualitative by nature. Thirteen of the studies included aimed to develop a theory about what works, for whom and under what circumstances regarding the investigated complex nursing intervention. One study was clearly embedded in the Medical Research Council's framework. CONCLUSION Realist evaluation broadens the methodologies that have traditionally been used in nursing. Conceptual clarity on its principal tenets is still needed, as well as the methods used to assess them. Nursing scientists should be more critical when using novel methodology and contribute to academic debates about limitations. Embedding realist evaluations into the Medical Research Council's framework is in its infancy in nursing and needs more contributions in order to develop a common academic position within the profession. Tweetable abstract Realist methodology in nursing - review of the use, methods, limitations and embedding into the Medical Research Council's framework.
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Affiliation(s)
- Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, 58453 Witten, Germany; German Center for Neurodegenerative Diseases, Site Witten, Stockumer Str. 12, 58453 Witten, Germany.
| | - Alexander Hochmuth
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, 58453 Witten, Germany
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Resciniti NV, Tang W, Tabassum M, Pearson JL, Spencer SM, Lohman MC, Ehlers DK, Al-Hasan D, Miller MC, Teixeira A, Friedman DB. Knowledge evaluation instruments for dementia caregiver education programs: A scoping review. Geriatr Gerontol Int 2020; 20:397-413. [PMID: 32133754 PMCID: PMC7748382 DOI: 10.1111/ggi.13901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/19/2019] [Accepted: 02/12/2020] [Indexed: 01/28/2023]
Abstract
With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non-RCTs = 6, one-group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi-country (n = 1). Only two studies focused on minority populations. While author-developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397-413.
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Affiliation(s)
- Nicholas V Resciniti
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Weizhou Tang
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Masroora Tabassum
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Joseph Lee Pearson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sharon Melinda Spencer
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Matthew C Lohman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Diane K Ehlers
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dana Al-Hasan
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Maggi C Miller
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Ana Teixeira
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Hurst A, Coyne E, Kellett U, Needham J. Volunteering in dementia care in an Australian hospital: A phenomenological study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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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Abstract
Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.
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Bamford C, Wheatley A, Shaw C, Allan LM. Equipping staff with the skills to maximise recovery of people with dementia after an injurious fall. Aging Ment Health 2019; 23:1524-1532. [PMID: 30428699 DOI: 10.1080/13607863.2018.1501664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: People with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explores the importance of compensating for cognitive impairment when working with people with dementia. Methods: Qualitative methods - interviews, focus groups and observation - were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. A thematic, iterative analysis was undertaken in which emerging themes were identified from each individual dataset, prior to an integrative analysis. Results: A key theme across all datasets was the need to deliver services in ways that compensate for cognitive impairment, such as negotiating meaningful activities that can be embedded into the routines of people with dementia. Professionals varied in their ability to adapt their practice to meet the needs of people with dementia. Negative attitudes towards dementia, a lack of knowledge and understanding of dementia limited the ability of some professionals to work in person-centred ways. Conclusion: Improving outcomes for people with dementia following a fall requires the principles of person-centred care to be enacted by professionals with a generic role, as well as specialist staff. This requires additional training and support by specialist staff to address the wide variability in current practice.
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Affiliation(s)
- Claire Bamford
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
| | - Caroline Shaw
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
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Kupeli N, Sampson EL, Leavey G, Harrington J, Davis S, Candy B, King M, Nazareth I, Jones L, Moore K. Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective. BMC Palliat Care 2019; 18:87. [PMID: 31651310 PMCID: PMC6813066 DOI: 10.1186/s12904-019-0467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how to provide optimal care. Previously, we reported a realist analysis of the health care professional perspective. Here, we report on family carer perspectives. We aimed to understand the similarities and differences between the two perspectives, gain insights into how the interdependent roles of family carers and HCPs can be optimised, and make recommendations for policy and practice. Method Qualitative study using a realist approach in which we used the criteria from guidance on optimal palliative care in advanced dementia to examine key contexts, mechanisms and outcomes highlighted by family carers. Results The themes and views of family caregivers resonate with those of health care professionals. Their overlapping anxieties related to business-driven care homes, uncertainty of families when making EOL decisions and the importance of symptom management referring to contexts, mechanisms and outcomes, respectively. Contexts specific to family carers were ad hoc information about services, dementia progression and access to funding. Not all family carers identified dementia as terminal, but many recognised the importance of continuity of care and knowing the wishes of the person with dementia. New mechanisms included specific resources for improving EOL care and barriers to discussing and planning for future care. Family carers identified the importance of comfort, being present, the meeting of basic care needs and feeling the right decisions have been made as good outcomes of care. Conclusions Family carers and health care professionals share similar concerns about the challenges to good EOL dementia care. Better understanding of the effects of dementia at the advanced stages would improve confidence in EOL care and reduce uncertainty in decision making for family carers and health care professionals.
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Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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75
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Hendlmeier I, Bickel H, Heßler-Kaufmann JB, Schäufele M. Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors. Z Gerontol Geriatr 2019; 52:212-221. [PMID: 31628613 PMCID: PMC6821661 DOI: 10.1007/s00391-019-01628-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.
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Affiliation(s)
- Ingrid Hendlmeier
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany.
| | - Horst Bickel
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Johannes Baltasar Heßler-Kaufmann
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Martina Schäufele
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany
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76
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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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Cerajewska TL, West NX. Dementia friendly dentistry for the periodontal patient. Part 2: ethical treatment planning and management. Br Dent J 2019; 227:570-576. [DOI: 10.1038/s41415-019-0728-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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78
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Brossard Saxell T, Ingvert M, Lethin C. Facilitators for person-centred care of inpatients with dementia: A meta-synthesis of registered nurses’ experiences. DEMENTIA 2019; 20:188-212. [DOI: 10.1177/1471301219871408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent in the hospital setting. Moreover, whilst registered nurses often wish to improve the in-hospital care of patients with dementia, there is evidence of experienced barriers. This study aimed to describe registered nurses’ experiences of facilitators for the delivery of person-centred care to inpatients with dementia. By way of systematic searches in the databases PubMed, CINAHL and PsycINFO, qualitative studies (n = 19) reporting registered nurses experience of caring for inpatients with dementia were identified. Relevant content was analysed using a method of thematic synthesis. Three main categories and nine subcategories were presented, internal facilitators (experience and knowledge; values and beliefs; professional identity; empathy), external facilitators (physical environment; organisational culture and structure) and facilitating actions (forming a holistic picture; establishing trust; adjusting routines and interventions). While facilitators did exist in the hospital setting, the findings indicate that care received by inpatients with dementia is dependent on individual registered nurses knowledge, personal aptitude and ability to compensate for structural flaws. In order to minimise arbitrary outcomes of care for patients with dementia, consistent organisational support in the form of educational interventions and allocation of resources is crucial.
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Affiliation(s)
| | | | - Connie Lethin
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Handley M, Bunn F, Goodman C. Supporting general hospital staff to provide dementia sensitive care: A realist evaluation. Int J Nurs Stud 2019; 96:61-71. [PMID: 30545567 DOI: 10.1016/j.ijnurstu.2018.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are an increasing number of interventions to improve hospital care for patients with dementia. Evidence for their impact on staff actions and patient outcomes is, however, limited and context dependent. OBJECTIVE To explain the factors that support hospital staff to provide dementia sensitive care and with what outcomes for patients with dementia. DESIGN A realist evaluation using a two-site case study approach. SETTING Two hospital trusts in the East of England. Site 1 had a ward for patients with dementia that would address their medical and mental health needs. Site 2 used a team of healthcare assistants, who had support from dementia specialist nurses, to work with patients with dementia across the hospital. PARTICIPANTS Hospital staff who had a responsibility for inpatients with dementia (healthcare assistants, nurses, medical staff, allied healthcare professionals and support staff) (n = 36), patients with dementia (n = 28), and family carers of patients with dementia (n = 2). METHODS A three stage realist evaluation: 1) building the programme theory of what works and when; 2) testing the programme theory through empirical data (80 h non-participant observation, 42 interviews, 28 patient medical notes, 27 neuropsychiatric inventory, and documentary review); 3) synthesis and verification of findings with key stakeholders. FINDINGS The programme theory comprised six interconnected context-mechanism-outcome configurations: 1) knowledge and authority to respond to an unmet need; 2) role relevant training and opportunities for reflection; 3) clinical experts and senior staff promoting practices that are patient-focused; 4) engaging with opportunities to spend time with patients; 5) risk management as an opportunity for person-centred care; 6) valuing dementia care as skilled work. Effective interactions reduced patient distress and supported patient orientation. Training and allocation of staff time were of themselves insufficient to ensure dementia care was prioritised and valued as skilled work. Staff concerns about the consequences of adverse incidents and work pressures on the ward, even with support, took precedence and influenced the quality of their interactions with patients with dementia. A key finding linked to staff retention and developing capacity in the workforce to provide expert dementia care was that despite extra training and organisational endorsement, nursing staff did not regard dementia care as skilled nursing work. CONCLUSIONS There is increased awareness and organisational commitment to dementia-friendly healthcare in general hospitals. However, in addition to training and adapting the environment to the patient, further work is needed to make explicit the specialist skills required for effective dementia care.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
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Motealleh P, Moyle W, Jones C, Dupre K. Creating a dementia-friendly environment through the use of outdoor natural landscape design intervention in long-term care facilities: A narrative review. Health Place 2019; 58:102148. [PMID: 31220798 DOI: 10.1016/j.healthplace.2019.102148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022]
Abstract
There is an increasing volume of literature on the positive effects of outdoor natural landscapes on health and well-being. However, to date, there is a paucity of research on the effect of outdoor natural landscapes designed for people with dementia living in long-term care (LTC) facilities, in particular, those which have incorporated the characteristics of a dementia-friendly environment (DFE). This narrative literature review synthesizes current knowledge on the effect of outdoor natural landscape design, which is aligned with the characteristics of a DFE, to improve agitation, apathy and engagement of people with dementia living in LTC facilities. The reviewed studies predominantly support the positive effects of outdoor natural landscapes on agitation, apathy and engagement of people with dementia. However, there are concerns about the methodological approaches, principles incorporated in the applied outdoor natural landscapes' designs, and the environmental assessment. Further rigorous research is required to understand the impact of the outdoor natural landscapes, with the application of DFE characteristics in the design, on agitation, apathy and engagement of people with dementia living in LTC facilities.
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Affiliation(s)
- Parinaz Motealleh
- School of Nursing and Midwifery, Griffith University, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Cindy Jones
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Karine Dupre
- School of Engineering and Built Environment, Griffith Architecture and Design, Australia; Griffith Institute for Tourism, Griffith University, Gold Coast, Australia.
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81
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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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Yamaguchi Y, Greiner C, Ryuno H, Fukuda A. Dementia nursing competency in acute care settings: A concept analysis. Int J Nurs Pract 2019; 25:e12732. [DOI: 10.1111/ijn.12732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/03/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yuko Yamaguchi
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Chieko Greiner
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Hirochika Ryuno
- Department of Gerontological Nursing, Graduate School of Health SciencesKobe University Kobe Japan
| | - Atsuko Fukuda
- Department of Adult Nursing, Graduate School of Health SciencesKobe University Kobe Japan
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83
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McConnell ES, Meyer J. Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges. Gerontol Geriatr Med 2019; 5:2333721419861198. [PMID: 31321255 PMCID: PMC6628510 DOI: 10.1177/2333721419861198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/25/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these individuals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using individual subjective assessment of personally relevant outcomes, often used to monitor care planning. Examples from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment.
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Affiliation(s)
- Eleanor S. McConnell
- Duke University School of Nursing, Durham, NC,
USA
- Geriatric Research Education and Clinical
Center, Durham Veterans Affairs Healthcare System, NC, USA
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84
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Burton JK, Guthrie B, Hapca SM, Cvoro V, Donnan PT, Reynish EL. Living at home after emergency hospital admission: prospective cohort study in older adults with and without cognitive spectrum disorder. BMC Med 2018; 16:231. [PMID: 30526577 PMCID: PMC6288896 DOI: 10.1186/s12916-018-1199-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim was to establish the role of CSDs on the likelihood of living at home 30 days after discharge or being newly admitted to a care home. METHODS A prospective cohort study with routine data linkage was conducted based on admissions data from the acute medical unit of a district general hospital in Scotland. 5570 people aged ≥ 65 years admitted from a private residence who survived to discharge and received the Older Persons Routine Acute Assessment (OPRAA) during an incident emergency medical admission were included. The outcome measures were living at home, defined as a private residential address, 30 days after discharge and new care home admission at hospital discharge. Outcomes were ascertained through linkage to routine data sources. RESULTS Of the 5570 individuals admitted from a private residence who survived to discharge, those without a CSD were more likely to be living at home at 30 days than those with a CSD (93.4% versus 81.7%; difference 11.7%, 95%CI 9.7-13.8%). New discharge to a care home affected 236 (4.2%) of the cohort, 181 (76.7%) of whom had a CSD. Logistic regression modelling identified that all four CSD categories were associated with a reduced likelihood of living at home and an increased likelihood of discharge to a care home. Those with delirium superimposed on dementia were the least likely to be living at home (OR 0.25), followed by those with dementia (OR 0.43), then unspecified cognitive impairment (OR 0.55) and finally delirium (OR 0.57). CONCLUSIONS Individuals with a CSD are at significantly increased risk of not returning home after hospitalisation, and those with CSDs account for the majority of new admissions to care homes on discharge. Individuals with delirium superimposed on dementia are the most affected. We need to understand how to configure and deliver healthcare services to enable older people to remain as independent as possible for as long as possible and to ensure transitions of care are managed supportively.
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Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building Glasgow Royal Infirmary, 10 Alexandra Parade, G31 2ER, Glasgow, Scotland
| | - Bruce Guthrie
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Simona M Hapca
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Vera Cvoro
- NHS Fife, Kirkcaldy, Fife, KY2 5AH, Scotland
| | - Peter T Donnan
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Emma L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, FK9 4LA, Scotland.
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85
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Petty S, Dening T, Griffiths A, Coleston DM. Meeting the Emotional Needs of Hospital Patients With Dementia: A Freelisting Study With Ward Staff. THE GERONTOLOGIST 2018; 60:155-164. [DOI: 10.1093/geront/gny151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stephanie Petty
- The Retreat, York
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Donna Maria Coleston
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
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86
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Hung L, Phinney A, Chaudhury H, Rodney P, Tabamo J, Bohl D. Appreciative Inquiry. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2018; 17:160940691876944. [DOI: 10.1177/1609406918769444] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Purpose: In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method: The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results: Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development. Conclusion: An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice.
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Affiliation(s)
- Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Alison Phinney
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Burnaby, Canada
| | - Paddy Rodney
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | | | - Doris Bohl
- Vancouver Coastal Health, Vancouver, Canada
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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88
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Sinvani L, Warner-Cohen J, Strunk A, Halbert T, Harisingani R, Mulvany C, Qiu M, Kozikowski A, Patel V, Liberman T, Carney M, Pekmezaris R, Wolf-Klein G, Karlin-Zysman C. A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score-Matched Analysis. J Am Geriatr Soc 2018; 66:1700-1707. [PMID: 30098015 DOI: 10.1111/jgs.15452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/22/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether a multicomponent intervention improves care in hospitalized older adults with cognitive impairment. DESIGN One-year retrospective chart review with propensity score matching on critical demographic and clinical variables was used to compare individauls with cognitive impairmenet on intervention and nonintervention units. SETTING Large tertiary medical center. PARTICIPANTS All hospitalized individuals age 65 and older with cognitive impairment admitted to medicine who required constant or enhanced observation for behavioral and psychological symptoms. INTERVENTION Multicomponent intervention (geographic unit cohorting, multidisciplinary approach, patient engagement specialists (PES), staff education) or usual care. MEASUREMENTS In-hospital mortality, length of stay, readmission, management of behavioral disturbances. RESULTS After propensity score matching, 476 of the 712 intervention visits were pair-matched with 476 of the 558 usual care visits. Matching was successful in balancing baseline covariates between intervention and usual care units. Individuals admitted to the intervention unit had lower in-hospital mortality (1.1% vs 2.9%, p=0.05) and shorter stays (5.0 vs 5.8 days, p=0.04). There was no difference in discharge home (p=0.90) or 30-day readmission rates (p=0.44). Individuals on the intervention unit were less likely than those receivng usual care to have an order for constant (12.0% vs 45.8%, p<0.01) or enhanced (22.1% vs 79.6%, p<0.01) observation, to be taking benzodiazepines (26.3% vs 38.0%, p<0.01), to be taking nothing by mouth (29.6% vs 40.8%, p=0.01), to be on bedrest (17.0% vs 25.8%, p=0.01), to be taking antipsychotics (41.2% vs 54.0%, p<0.01), or to have restraints (3.2% vs 6.9%, p=.01). CONCLUSION A multicomponent intervention of geographic cohorting, multidisciplinary approach, PES, and staff education may offer a new paradigm in the management of hospitalized older adults with cognitive impairment.
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Affiliation(s)
- Liron Sinvani
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York
| | - Jessy Warner-Cohen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Department of Psychology, Northwell Health, New Hyde Park, New York
| | - Andrew Strunk
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York
| | - Travis Halbert
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York
| | - Ruchika Harisingani
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York
| | - Colm Mulvany
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York
| | - Michael Qiu
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York
| | - Andrzej Kozikowski
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Division of Geriatric and Palliative Medicine, Department of Medicine, Northwell Health, New Hyde Park, New York
| | - Vidhi Patel
- Division of Geriatric and Palliative Medicine, Department of Medicine, Northwell Health, New Hyde Park, New York
| | - Tara Liberman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Division of Geriatric and Palliative Medicine, Department of Medicine, Northwell Health, New Hyde Park, New York
| | - Maria Carney
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Division of Geriatric and Palliative Medicine, Department of Medicine, Northwell Health, New Hyde Park, New York
| | - Renee Pekmezaris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Division of Health Services Research, Department of Medicine, Northwell Health, Manhasset, New York
| | - Gisele Wolf-Klein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York.,Division of Geriatric and Palliative Medicine, Department of Medicine, Northwell Health, New Hyde Park, New York
| | - Corey Karlin-Zysman
- Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York
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Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals. Int Psychogeriatr 2018; 30:991-1000. [PMID: 29122058 DOI: 10.1017/s104161021700240x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:In April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings. METHODS A national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was "use of physical restraint." RESULTS Among patients, the point prevalence of physical restraint was 44.5% (n = 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]). CONCLUSIONS The financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.
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