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Abbott RA, Cheeseman D, Hemsley A, Thompson Coon J. Can person-centred care for people living with dementia be delivered in the acute care setting? Age Ageing 2021; 50:1077-1080. [PMID: 33890625 PMCID: PMC8244565 DOI: 10.1093/ageing/afab065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
The need to improve care for people living with dementia in the hospital setting has long been recognised. Person-centred care has the potential to improve the experience of care for persons living with dementia and their carers, and has been shown to improve the experiences of hospital staff caring for the persons living with dementia, however it remains challenging to deliver in a time- and task-focussed acute care setting. This commentary suggests that to embed person-centred care across the hospital environment, cultural changes are needed at organisational and ward levels. In particular there needs to be: leadership that supports and advocates for workforce capacity to recognise and meet both psychological and physical needs of people living with dementia, promotion of physical environments that support familiarisation and social interactions, an inclusive approach to carers and the development of a culture of sharing knowledge and information across hierarchies and roles. An evidence-based set of pointers for service change are described which highlight institutional and environmental practices and processes that need to be addressed in order for person-centred care to become part of routine care.
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Affiliation(s)
- Rebecca A Abbott
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | | | - Anthony Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Jo Thompson Coon
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
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2
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Lämmler G. [Treating patients with dementia sustainably]. Z Gerontol Geriatr 2020; 53:359-361. [PMID: 32367171 DOI: 10.1007/s00391-020-01731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gernot Lämmler
- Johannesstift Diakonie, Evangelisches Geriatriezentrum Berlin gGmbH, Reinickendorfer Str. 61, 13347, Berlin, Deutschland.
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Kroll L, Böhning N, Müßigbrodt H, Stahl M, Halkin P, Liehr B, Grunow C, Kujumdshieva-Böhning B, Freise C, Hopfenmüller W, Friesdorf W, Jockers-Scherübl M, Somasundaram R. Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study. BMC Psychiatry 2020; 20:165. [PMID: 32295567 PMCID: PMC7161155 DOI: 10.1186/s12888-020-02573-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Agitation is common in geriatric patients with cognitive impairment, e.g. in persons with dementia (PWD), who are admitted to an emergency department (ED). It might be a first sign of upcoming delirium and is associated with a higher risk of an unfavorable clinical course. Hence, monitoring of vital signs and enhanced movement as indicators of upcoming agitation is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, a novel developed non-contact monitoring system (NCMSys) might represent an appropriate alternative. Aim of this feasibility study was to test the validity of a NCMSys and of the tent-like "Charité Dome" (ChD), aimed to shelter PWD from the busy ED environment. Furthermore, effects of the ChD on wellbeing and agitation of PWD were investigated. METHODS Both devices were attached to patient's bed. Tests on technical validity and safety issues of NCMSys and ChD were performed at the iDoc institute with six healthy volunteers. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. 19 patients were included, ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥ 55 years, a dementia diagnosis and a written consent (by patients or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. RESULTS Measurements of heart rate, changes in movement and sound emissions by the NCMSys were valid, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients' vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. CONCLUSIONS The results of this feasibility study encourage a future controlled clinical trial in geriatric ED patients, including PWD, to further evaluate if our concept of non-contact measurement of vital signs and movement combined with the "Charité Dome" helps to prevent upcoming agitation in this vulnerable patient group in the ED. TRIAL REGISTRATION ICTRP: "Charité-Dome-Study - DRKS00014737" (retrospectively registered).
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Affiliation(s)
- Lisa Kroll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Nikolaus Böhning
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Heidi Müßigbrodt
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Maria Stahl
- grid.6734.60000 0001 2292 8254Technical University of Berlin— Institute of Psychology and Ergonomics, Berlin, Germany
| | - Pavel Halkin
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Birgit Liehr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Christine Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Christian Freise
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Werner Hopfenmüller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Wolfgang Friesdorf
- HCMB – Institute for Health Care Systems Management Berlin eG, Berlin, Germany
| | - Maria Jockers-Scherübl
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Rajan Somasundaram
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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4
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Wunner C, Rupprecht R, Singler K, Söllner W, Waller C, Gosch M, Schubert A. Therapie mit Demenzkranken in einer geriatrischen Tagesklinik. Z Gerontol Geriatr 2020; 53:123-128. [DOI: 10.1007/s00391-019-01683-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
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Manietta C, Vogt B, Roes M. [Dementia-specific characteristics of patients with fall-related femur fractures : A case study based on routine hospital data of patients with unspecified dementia]. Z Gerontol Geriatr 2019; 53:437-445. [PMID: 31696362 DOI: 10.1007/s00391-019-01641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A fall-related femur fracture is one of the most frequent reasons for hospital admission of patients with dementia. The aim of the study was to identify dementia-specific characteristics of patients with fall-related femur fractures and additionally an unspecified dementia in order to gain further knowledge about this particular patient group. METHODS A descriptive explorative case study with a single case-embedded design based on routine hospital data from a university hospital was performed. A total number of 34 patient records from 2015 were analyzed. In the embedded unit of analysis I the data of selected items of the nursing assessment AcuteCare (ePA-AC©) were descriptively analyzed for the time of admission and discharge. In the embedded unit of analysis II a summarizing inductive content analysis was conducted. RESULTS The results of the embedded unit of analysis I showed that this patient group is characterized by a high need for care, changes of cognition and behavioral symptoms. The status of cognition, behavior and reciprocity as well as the self-care index stagnated or deteriorated in many patients from admission to discharge. The embedded unit of analysis II identified observable (social)behavior, (non)compliance and orientation as central dementia-specific characteristics. CONCLUSION The results reflect the complexity of the care situation of patients with unspecified dementia in acute care hospitals. The results showed that a higher awareness for this particular patient group is needed to improve outcomes.
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Affiliation(s)
- Christina Manietta
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Private Universität Witten/Herdecke gGmbH, Witten/Herdecke, Deutschland. .,Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland.
| | - Birgit Vogt
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Private Universität Witten/Herdecke gGmbH, Witten/Herdecke, Deutschland.,Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martina Roes
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Private Universität Witten/Herdecke gGmbH, Witten/Herdecke, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Witten, Deutschland
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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.
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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
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8
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[Community-based psychosocial care for people with dementia]. Z Gerontol Geriatr 2017; 50:609-615. [PMID: 28983680 DOI: 10.1007/s00391-017-1316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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9
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Kopf D, Hewer W. [Feasible and effective treatment approaches with physical and mental comorbidities]. Z Gerontol Geriatr 2017; 50:97-98. [PMID: 28154897 DOI: 10.1007/s00391-017-1182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Kopf
- Kath. Marienkrankenhaus GmbH, Alfredstr. 9, 22087, Hamburg, Deutschland.
| | - Walter Hewer
- Klinik für Gerontopsychiatrie, Klinikum Christophsbad, Faurndauer Str. 6-28, 73035, Göppingen, Deutschland.
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Nau R, Djukic M, Wappler M. [Geriatrics: interdisciplinary cooperation and acquisition of knowledge]. DER NERVENARZT 2016; 87:1113-1114. [PMID: 27573886 DOI: 10.1007/s00115-016-0206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- R Nau
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Institut für Neuropathologie, Universitätsmedizin Göttingen, An der Lutter 24, 37075, Göttingen, Deutschland.
| | - M Djukic
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Institut für Neuropathologie, Universitätsmedizin Göttingen, An der Lutter 24, 37075, Göttingen, Deutschland
| | - M Wappler
- Zentrum für Geriatrie, Neurogeriatrie und Neurologische Frührehabilitation, Evangelisches Krankenhaus Gesundbrunnen, Hofgeismar, Deutschland
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Büter K, Motzek T, Dietz B, Hofrichter L, Junge M, Kopf D, von Lützau-Hohlbein H, Traxler S, Zieschang T, Marquardt G. [Dementia-friendly hospital wards : Expert recommendations for planning and design]. Z Gerontol Geriatr 2016; 50:67-72. [PMID: 27325444 DOI: 10.1007/s00391-016-1079-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/13/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.
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Affiliation(s)
- K Büter
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland
| | - T Motzek
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland
| | - B Dietz
- Fakultät für Architektur, Krankenhausbau und Bauten des Gesundheitswesens, TU München, München, Deutschland.,Fakultät für Medizin, TU München, München, Deutschland.,Bayerisches Institut für alters- und demenzsensible Architektur, München, Deutschland
| | - L Hofrichter
- Fachbereich Life Science Engineering LSE, THM Technische Hochschule Mittelhessen, Gießen, Deutschland
| | - M Junge
- Diakonissenkrankenhaus Dresden, Dresden, Deutschland
| | - D Kopf
- Katholisches Marienkrankenhaus Hamburg, Hamburg, Deutschland
| | - H von Lützau-Hohlbein
- Selbsthilfe Demenz/Alzheimer Europe, Deutsche Alzheimer Gesellschaft e. V., Berlin, Deutschland
| | - S Traxler
- wörner traxler richter planungsgesellschaft mbh, Dresden, Deutschland
| | - T Zieschang
- Agaplesion Bethanien Krankenhaus Heidelberg, Heidelberg, Deutschland
| | - G Marquardt
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland.
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von Renteln-Kruse W, Neumann L, Klugmann B, Liebetrau A, Golgert S, Dapp U, Frilling B. Geriatric patients with cognitive impairment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:103-12. [PMID: 25780869 DOI: 10.3238/arztebl.2015.0103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitals are now faced with increasing numbers of cognitively impaired patients aged 80 and older who are at increased risk of treatment complications. This study concerns the outcomes when such patients are treated in a specialized ward for cognitive geriatric medicine. METHODS Observation of a cohort of 2084 patients from 2009 to 2014, supplemented by a sample of 380 patients from the hospital cohort of the Longitudinal Urban Cohort Ageing Study (LUCAS) for the years 2010 and 2011. RESULTS Geriatric inpatients with cognitive impairment tend to be multimorbid. Half of the patients studied (1031 of 2084 patients) were admitted to the hospital on an emergency basis. Complications arising on the ward that necessitated transfer elsewhere arose in 2.6% (51 of 2084 patients). Moreover, analysis of the sample of 380 patients from the LUCAS cohort revealed that the treatments they underwent during hospitalization were associated with an improvement of their functional state: their mean overall score on the Barthel index rose from 39.8 ± 24.3 (median, 35) on admission to 52.7 ± 27.0 (median, 55) on discharge. The percentage of patients being treated with 5 or more drugs fell from 98.2% (373/380) on admission to 79.3% (314/362) on discharge. The percentage receiving potentially inappropriate medications (PIM), as defined by the PRISCUS list, fell from 45% to 13.3%, while the percentage of drug orders and prescriptions involving PIM fell from 7.8 % (327/4181) to 2.0% (53/2600). 70% of the patients were discharged to the same living situation where they had been before admission. CONCLUSION In this study, structured geriatric treatment in a cohort of older acutely ill patients with cognitive impairment was associated with improvement of functions that are relevant to everyday life, as well as with a reduction of polypharmacy. Controlled studies are needed to confirm the observed benefit.
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Affiliation(s)
- Wolfgang von Renteln-Kruse
- Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Hamburg, Germany, Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Research Department, Hamburg Germany, Albertinen-Hospital, Department of Medical Controlling, Hamburg, Germany
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Rösler A, Pfeil S, Lessmann H, Höder J, Befahr A, von Renteln-Kruse W. Dysphagia in Dementia: Influence of Dementia Severity and Food Texture on the Prevalence of Aspiration and Latency to Swallow in Hospitalized Geriatric Patients. J Am Med Dir Assoc 2015; 16:697-701. [DOI: 10.1016/j.jamda.2015.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Komorbide Erkrankungen bei Demenz. Z Gerontol Geriatr 2015; 48:303-4. [DOI: 10.1007/s00391-015-0897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hermann DM, Muck S, Nehen HG. Supporting dementia patients in hospital environments: health-related risks, needs and dedicated structures for patient care. Eur J Neurol 2014; 22:239-45, e17-8. [PMID: 25103994 DOI: 10.1111/ene.12530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
Abstract
The diagnostics and treatment of dementia are progressively gaining importance for European neurologists. Our hospital structures are poorly prepared for patients suffering from dementia. As a consequence of cognitive and physical deficits, dementia patients have an increased risk for serious complications and poor outcomes in hospital environments. In this review, the specific needs of dementia patients are outlined, describing how geriatricians, neurologists and psychiatrists may contribute to better patient care, e.g. with consultation or liaison services, geriatric wards, dedicated dementia wards or memory clinics in interaction with nurses, occupational therapists, physiotherapists, speech therapists, psychologists and social workers. Due to their multifaceted needs, dementia patients can most successfully be supported in clinical environments that closely integrate specialized inpatient, outpatient and primary care offers.
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Affiliation(s)
- D M Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany
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