1
|
Graham FA, Kelly L, Burmeister EA, Henderson A, Broome A, Hubbard RE, Gordon EH. The impact of a hospital-based special care unit on behavioural and psychological symptoms in older people living with dementia. Age Ageing 2024; 53:afae081. [PMID: 38644744 DOI: 10.1093/ageing/afae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Hospital patients with behavioural and psychological symptoms of dementia (BPSD) are vulnerable to a range of adverse outcomes. Hospital-based Special Care Units (SCUs) are secure dementia-enabling environments providing specialised gerontological care. Due to a scarcity of research, their value remains unconfirmed. OBJECTIVE To compare hospital based SCU management of BPSD with standard care. DESIGN Single-case multiple baseline design. SETTING AND PARTICIPANTS One-hundred admissions to an 8-bed SCU over 2 years in a large Australian public hospital. METHODS Repeated measures of BPSD severity were undertaken prospectively by specialist dementia nurses for patients admitted to a general ward (standard care) and transferred to the SCU. Demographic and other clinical data, including diagnoses, medication use, and care-related outcomes were obtained from medical records retrospectively. Analysis used multilevel models to regress BPSD scores onto care-setting outcomes, adjusting for time and other factors. RESULTS When receiving standard care, patients' BPSD severity was 6.8 (95% CI 6.04-7.64) points higher for aggression, 15.6 (95% CI 13.90-17.42) points higher for the neuropsychiatric inventory, and 5.8 (95% CI 5.14-6.50) points higher for non-aggressive agitation compared to SCU. Patients receiving standard care also experienced increased odds for patient-to-nurse violence (OR 2.61, 95% CI 1.67-4.09), security callouts (OR 5.39 95% CI 3.40-8.52), physical restraint (OR 17.20, 95% CI 7.94-37.25) and antipsychotic administration (OR 3.41, 95% CI 1.60-7.24). CONCLUSION Clinically significant reductions in BPSD and psychotropic administration were associated with SCU care relative to standard ward care. These results suggest more robust investigation of hospital SCUs, and dementia-enabling design are warranted.
Collapse
Affiliation(s)
- Frederick A Graham
- Division of Medicine, Princess Alexandra Hospital, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Queensland, Australia
| | - Lisa Kelly
- Department of Geriatric Medicine, Princess Alexandra Hospital, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Queensland, Australia
| | | | - Amanda Henderson
- Nursing Practice Development Unit, Princess Alexandra Hospital, Queensland, Australia
- School of Nursing, Faculty of Nursing, Midwifery and Social Sciences, Central Queensland University, Queensland, Australia
| | - Annette Broome
- Department of Psychology, Princess Alexandra Hospital, Queensland, Australia
- School of Psychology, The University of Queensland, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Queensland, Australia
| |
Collapse
|
2
|
Zieschang T, Bauer J, Kopf D, Rösler A. [Special care units for patients with cognitive impairment : Results of a nationwide survey in geriatric hospitals in Germany]. Z Gerontol Geriatr 2018; 52:598-606. [PMID: 30178120 DOI: 10.1007/s00391-018-1439-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/18/2018] [Accepted: 08/07/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND A large number of older acutely ill patients with cognitive impairment are treated in geriatric care units. Since 1990 some geriatric departments in Germany have established special care units (SCU) for this patient population. In 2010 the first inventory of SCUs in Germany was carried out, which was not based on a nationwide systematic survey. OBJECTIVE Nationwide systematic survey of SCUs for patients with cognitive impairment in geriatric institutions in Germany. METHODS An online questionnaire (SurveyMonkey®, San Mateo, CA, USA) was sent to all heads of geriatric departments that provide advanced education in geriatric medicine of at least 12 months as registered by the German Society for Geriatric Medicine (DGG). RESULTS The questionnaire was sent to 495 geriatric institutions of which 161 answered (response rate 32.5%). Additionally, 13 institutions answered through a weblink sent in a newsletter by the DGG. In 2017 a total of 42 SCUs existed with a mean size of 13.5 ± 4.7 beds. A further 15 hospitals plan to install an SCU in the near future, 5 probably in 2018. In four geriatric departments an existing SCU was closed down. All SCUs implemented special architectural, structural and personnel measures as recommended by the position paper of the DGG. The few conducted evaluations indicated beneficial results for mobility and disruptive behavior. CONCLUSION In recent years the number of SCUs has increased considerably. A methodologically sound evaluation with respect to patient-related outcomes including follow-up and cost-effectiveness is lacking and should be carried out in the near future.
Collapse
Affiliation(s)
- Tania Zieschang
- Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacherstraße 149, 69126, Heidelberg, Deutschland.
| | - Jürgen Bauer
- Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacherstraße 149, 69126, Heidelberg, Deutschland
| | - Daniel Kopf
- Kath. Marienkrankenhaus gGmbH, Alfredstraße 9, 22087, Hamburg, Deutschland
| | - Alexander Rösler
- Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Deutschland
| |
Collapse
|
3
|
White EM, Smith JG, Trotta RL, McHugh MD. Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce. J Am Geriatr Soc 2018; 66:1137-1143. [PMID: 29558568 PMCID: PMC6105464 DOI: 10.1111/jgs.15355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. DESIGN Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states. SETTING Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531). PARTICIPANTS Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170). MEASUREMENTS Thirty-day mortality and failure to rescue (death after a complication). RESULTS Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92-0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. CONCLUSION Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.
Collapse
Affiliation(s)
- Elizabeth M White
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica G Smith
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca L Trotta
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Backhouse T, Camino J, Mioshi E. What Do We Know About Behavioral Crises in Dementia? A Systematic Review. J Alzheimers Dis 2018; 62:99-113. [DOI: 10.3233/jad-170679] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Julieta Camino
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
5
|
Hofmann W, Rösler A, Vogel W, Nehen HG. [Special care units for acutely ill patients with cognitive impairment in Germany. Position paper]. Z Gerontol Geriatr 2014; 47:136-40. [PMID: 24619045 DOI: 10.1007/s00391-014-0612-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia is an increasing challenge for care providers in nursing homes and hospitals. Since the 1980s, special acute care units in nursing homes have developed rapidly. In Germany, the first unit in a hospital opened in 1990. In 2013, there were 22 units. MATERIALS AND METHODS In the following paper, the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie e. V.") recommends basic standards for these wards. RESULTS The basic standards for these wards include the following: a maximum of 20 beds, an area physically separated from the geriatric hospital department, their own dayroom and therapy room, a structured daily routine suitable for patients with dementia, the selection of permanent staff on a voluntary basis, specialized training, extended geriatric assessment, and special consideration of the background and social situation of the patients.
Collapse
Affiliation(s)
- W Hofmann
- Deutsche Gesellschaft für Geriatrie (DGG) e. V., Kunibertskloster 11-13, 50668, Köln, Deutschland,
| | | | | | | |
Collapse
|
6
|
Pezzati R, Molteni V, Bani M, Settanta C, Di Maggio MG, Villa I, Poletti B, Ardito RB. Can Doll therapy preserve or promote attachment in people with cognitive, behavioral, and emotional problems? A pilot study in institutionalized patients with dementia. Front Psychol 2014; 5:342. [PMID: 24795682 PMCID: PMC4001059 DOI: 10.3389/fpsyg.2014.00342] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/01/2014] [Indexed: 12/14/2022] Open
Abstract
Doll therapy is a non-pharmacological intervention aimed at reducing behavioral and psychological disorders in institutionalized patients with dementia. This therapy as a care tool has been integrated into the context of long-term care institutions, in which the need to find solutions to cognitive, behavioral and emotional problems showed by people with dementia meets the primary objective of developing good care practices focusing on patients and their needs. In the present work we adopt the Bowlby's theory of attachment to investigate the effectiveness of Doll therapy. The hypothesis that we here propose is that the emotional experience of the person with dementia during Doll therapy activates caregiving and exploration systems together with the attachment one. To test this hypothesis we compared institutionalized patients with dementia undergoing Doll therapy with a control group and assessed measures of the relational dimension with the environment, such as gaze direction, behaviors of exploration, and behaviors of caregiving. We used an experimental protocol consisting of 10 non-consecutive sessions structured with the goal of recreating a situation of (1) separation from a known figure and (2) interaction with the environment in order to partially recreate the prototypical phases of the "Strange situation." All sessions were videotaped and analyzed through an observational grid. Results support the effectiveness of Doll therapy in promoting and maintaining the affective-relational dimension of attachment-caregiving and the attentive dimension of exploration in patients with advanced stage of dementia. Thus, our results suggest that the use of Doll therapy promotes clinically significant improvements in the ability to relate with the surrounding world. This may be important for managing and caring for patients with dementia in institutionalized context.
Collapse
Affiliation(s)
- Rita Pezzati
- University of Applied Sciences and Arts of Southern Switzerland Manno, Switzerland ; Centro Terapia Cognitiva Como, Italy
| | - Valentina Molteni
- Centro Terapia Cognitiva Como, Italy ; Istituti Riuniti Airoldi e Muzzi Onlus Lecco, Italy
| | | | - Carmen Settanta
- Center for Cognitive Science, Department of Psychology, University of Turin Turin, Italy
| | | | - Ivan Villa
- Istituti Riuniti Airoldi e Muzzi Onlus Lecco, Italy
| | - Barbara Poletti
- University of Applied Sciences and Arts of Southern Switzerland Manno, Switzerland ; Department of Neurology and Laboratory of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano Milan, Italy
| | - Rita B Ardito
- Center for Cognitive Science, Department of Psychology, University of Turin Turin, Italy
| |
Collapse
|
7
|
Villars H, Dupuy C, Soler P, Gardette V, Soto ME, Gillette S, Nourhashemi F, Vellas B. A follow-up intervention in severely demented patients after discharge from a special Alzheimer acute care unit: impact on early emergency room re-hospitalization rate. Int J Geriatr Psychiatry 2013; 28:1131-40. [PMID: 23348897 DOI: 10.1002/gps.3932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/19/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Emergency room (ER) re-hospitalizations are prevalent in severe Alzheimer's disease affected older patients. DESIGN Quasi-experimental before and after study. SETTING Discharge of severely demented patients from a Special Alzheimer Acute Care Unit. PARTICIPANTS A total of 390 patients hospitalized in the unit from 2007 through 2009, with at least one of the following characteristics: severe disruptive behavioral and psychological symptoms of dementia (BPSD) (agitation, aggressiveness, and psychotic symptoms), change of living arrangement related to BPSD, exhaustion of the principal caregiver, and discharge of a subject with anosognosia living alone in the community. INTERVENTION The intervention consisted of an individualized care plan, targeting the problems observed during the hospital stay, implemented by the means of regular telephone contacts (in the first week after discharge, before the end of the first month, and then at 3 and 6 months) between a geriatric team and the patient's caregiver. Information was gathered on functional decline, BPSD, change of living arrangement and treatment. The calls were followed by a telephone intervention providing advice, support, and information to the caregiver. When required, these calls were followed by a consultation with a physician or psychologist, or by a consultation in the patient's home. MEASUREMENTS The primary outcome measure was the ER re-hospitalization rate, defined as occurring within 31 days of discharge. RESULTS The early ER re-hospitalization rate was 8.39% in 2007 versus 8.02% in 2008 (p = 0.818) and 7.47% in 2009 (p = 0.563). Vocal disruptive behavior are more prevalent in re-hospitalized patients (9.64% versus 3.97%, p = 0.05) than in non re-hospitalized patients. CONCLUSION We found a nonsignificant decrease of early ER re-hospitalization rate at 1 month after discharge. Interventions addressing severe dementia affected patients with BPSD are needed, as this is a major issue in the organization of health care systems.
Collapse
Affiliation(s)
- Hélène Villars
- Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Predictors of prolonged hospital stay for the treatment of severe neuropsychiatric symptoms in patients with dementia: a cohort study in multiple hospitals. Int Psychogeriatr 2013; 25:1365-73. [PMID: 23611561 DOI: 10.1017/s1041610213000483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Long hospitalization is often needed to treat severe behavioral and psychological symptoms of dementia (BPSD), which places heavy demands on hospital resources. Consequently, patients with severe BPSD usually wait for a long time to be admitted. There is a need to identify factors related to long hospitalization to better manage resources of a psychiatric hospital. METHODS We surveyed 150 consecutive patients hospitalized in the neuropsychiatric units of three hospitals for treatment of BPSD from 11 May 2009 to 30 November 2010. Only patients with reliable relatives were included in the study. We evaluated data of the patients (demographics, cognitive impairment, activities of daily living, causal disease for dementia, dementia severity, and the amount of pension), their primary caregivers (demographics and care burden), and their doctors' years of experience in treating dementia. We followed up to 180 days and assessed the effect of these factors on the length of stay. RESULTS Of the 150 patients, 104 were discharged within 180 days and 46 were hospitalized for more than 180 days. Average length of stay for patients was 110.4 ± 58.1 days. In both univariate and multivariate Cox proportional hazard analyses, length of stay was longer for patients with smaller pensions and patients whose doctors had fewer years of experience in treating dementia. Length of stay was not found to be associated with any of the other variables. CONCLUSIONS Patients with smaller pensions and whose doctors had less experience in treating dementia tended to require longer hospitalization.
Collapse
|
9
|
Taniguchi S, Narumoto J, Shibata K, Ayani N, Matsuoka T, Okamura A, Nakamura K, Shimizu H, Fukui K. Treatment in a ward for elderly patients with dementia in Japan. Neuropsychiatr Dis Treat 2013; 9:357-63. [PMID: 23494174 PMCID: PMC3593760 DOI: 10.2147/ndt.s41581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Japan has become the world's most aged country. The percentage of elderly people in Japan is estimated to reach 25.2% in 2013, and the number of patients with dementia is estimated to reach 2.5 million in 2015. In addition to its deterioration of physical function and activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD) often become major clinical problems, greatly annoying patients and their caregivers. In Japan, we utilize wards for elderly patients with dementia (WEDs) for BPSD treatment. However, there are few studies investigating the effectiveness of treatment in a WED. In such treatment, physical complications are a challenge physicians must overcome while treating BPSD and safely returning patients home or to the institutions in which they live. Therefore, we investigated the effectiveness of treatment in a WED, focusing on physical complications. METHODS The subjects were 88 patients who were admitted to and discharged from a WED. Severity of dementia, basic ADL, and BPSD were investigated using the Clinical Dementia Rating, Physical Self-Maintenance Scale (PSMS), and Neuropsychiatric Inventory. Differences in characteristics between patients discharged from the WED because of physical complications and all other patients were also examined. RESULTS We found significant improvements in the PSMS score and decreases in delusions and sleep disturbances in all patients. Patients discharged from the WED because of physical complications had significantly greater severity of dementia at discharge compared to all other patients. CONCLUSION Treatment in a WED seems to be effective for BPSD and ADL, but care should be taken regarding physical complications, especially in patients with advanced dementia.
Collapse
Affiliation(s)
- Shogo Taniguchi
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). RECENT FINDINGS Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. SUMMARY The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.
Collapse
Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| |
Collapse
|
11
|
Restifo S, Lemon V, Waters F. Pharmacological treatment of behavioural and psychological symptoms of dementia in psychogeriatric inpatient units. Australas Psychiatry 2011; 19:59-63. [PMID: 21189108 DOI: 10.3109/10398562.2010.539611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study involved an examination of the current patterns of pharmacological treatment of patients with behavioural and psychological symptoms of dementia (BPSD) in psychogeriatric inpatient units. METHOD An audit was conducted of discharge medications of patients with BPSD who were hospitalized at three separate inpatient units in Perth, Western Australia over a 1-year period. RESULTS Prescribing patterns were found to be relatively similar across the three units. Dementia-specific drugs such as choline-esterase inhibitors and memantine comprised a minority of prescribed medication. Antipsychotics, benzodiazepines and sodium valproate were the most commonly prescribed drugs. Cyproterone acetate was used in a small number of patients at each of the three units. CONCLUSIONS The broad range of medications used to treat BPSD, the relatively modest place of dementia-specific drugs in this patient group, and the co-prescribing of more than one psychotropic agent in the majority of patients support the prevailing impressions that BPSD are difficult to treat and that there is no consistently effective or superior medication or drug group.
Collapse
Affiliation(s)
- Sam Restifo
- North Metropolitan Area Older Adult Mental Health Service, Perth, WA, Australia.
| | | | | |
Collapse
|
12
|
Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study. Int Psychogeriatr 2010; 22:139-46. [PMID: 19602306 DOI: 10.1017/s1041610209990494] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes. METHODS The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxon's, McNemar tests, pre-post design). RESULTS 332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 +/- 8.3 vs. 15.0 +/- 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001). CONCLUSIONS The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.
Collapse
|
13
|
Zieschang T, Dutzi I, Müller E, Hestermann U, Specht-Leible N, Grünendahl K, Braun A, Hüger D, Oster P. A special care unit for acutely ill patients with dementia and challenging behaviour as a model of geriatric care. Z Gerontol Geriatr 2008; 41:453-9. [PMID: 19190868 DOI: 10.1007/s00391-008-0023-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 10/14/2008] [Indexed: 01/28/2023]
Abstract
This paper describes the development and management of a new model of care for hospitalized patients with challenging behaviour evoked by dementia and/or delirium. To ameliorate care for patients with dementia in a geriatric acute care hospital a segregated Special Care Unit for patients with challenging behaviour was created. Environmental features allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Day-time activities structure the day and assure additional professional presence in the unit. An intensive training program for the staff was provided. The SCU has been well accepted by the staff and is considered to be an improvement in care. Psychological burden of the nurses did not increase over a time period of one year in caring for these difficult patients.
Collapse
Affiliation(s)
- Tania Zieschang
- Bethanien Krankenhaus, Geriatrisches Zentrum an der Universität Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|