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Turner SG, Pillemer K, Demetres M, Heaney K, Joshi S, Luebke M, Messay G, Reid MC. Physical pain among family caregivers to older adults: A scoping review of the literature. J Am Geriatr Soc 2024. [PMID: 38895995 DOI: 10.1111/jgs.19037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Scholarship on the health of family caregivers to older adults continues to expand. Although existing research suggests that many family caregivers experience pain, which impacts their ability to perform caregiving tasks and is associated with care recipients' unmet needs, the scope of research on family caregivers' pain remains poorly characterized. We conducted a scoping review of research on pain among family caregivers to older adults to characterize existing evidence and identify knowledge gaps. METHODS We searched multiple databases spanning from January 2012 to July 2023, identified eligible studies using predefined inclusion/exclusion criteria, and extracted key data (e.g., study design/methodology, pain measurement, caregiver pain type, and major findings). RESULTS We identified 46 eligible studies conducted in the United States (n = 19) and internationally (n = 27). Studies often focused on caregivers for older adults with specific health conditions, such as cancer (n = 11), dementia (n = 8), or stroke (n = 3). The most commonly employed pain measure was a single-item dichotomous question about pain (n = 16), followed by a visual numeric or visual analog scale (n = 11). Nine studies (five randomized controlled trials) reported on five caregiver pain management interventions, including yoga/exercise programs and caregiver education programs. DISCUSSION Existing research on family caregivers' pain offers an important foundation. However, more robust research designs are necessary. We identify possibilities for future studies in addition to opportunities for systematic investigations to support the family caregivers being relied upon to care for the increasing number of older adults.
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Affiliation(s)
- Shelbie G Turner
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen Heaney
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Sama Joshi
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Matthew Luebke
- College of Human Ecology, Cornell University, Ithaca, New York, USA
- Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Gelila Messay
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- Translational Research Institute on Pain in Later Life, Weill Cornell Medicine, New York, New York, USA
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Wang S, Huang Y, Fan AYN, Ho MH, Davidson PM. Factors influencing the psychosocial well-being of people with dementia and their informal caregivers: A systematic review of dyadic studies. Int J Ment Health Nurs 2024; 33:560-581. [PMID: 38131462 DOI: 10.1111/inm.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
Individuals with dementia and their informal caregivers face significant challenges to their psychosocial well-being, necessitating immediate attention. In spite of the prevalence of this problem, there is limited data regarding the factors that influence the dyadic psychosocial well-being and potential actor-partner influencing mechanisms. Therefore, this review was conducted to synthesise the factors associated with the psychosocial well-being of people with dementia and their informal caregivers. MEDLINE via EBSCOhost, CINAHL, PsycINFO, Embase and Scopus were systematically searched to identify relevant studies. Quantitative, qualitative or mixed-method studies examining the factors influencing dyadic psychosocial well-being outcomes were included. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal checklists. A narrative synthesis approach was employed for data analysis. A total of 3217 records were yield, out of which 26 studies were included in the analysis. Quality of life emerged as the most extensively investigated dyadic psychosocial well-being outcome, followed by depression. The interrelation between the quality of life for people with dementia and caregivers was observed, where individual members' quality of life was influenced by their own, partner and dyadic factors. However, there is a dearth of research exploring the mechanisms through which one member's factors exert influence on both their own and partner's quality of life within the dyad. This gap also exists for other psychosocial well-being outcomes, such as depression and anxiety. Further research is warranted to elucidate the underlying mechanisms through which dyadic members influence their own and their partner's psychosocial well-being.
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Affiliation(s)
- Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yaqi Huang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Avis Yat Ngar Fan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
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Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [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: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
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Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Natavio T, McQuillen E, Dietrich MS, Wells N, Rhoten BA, Vallerand AH, Monroe TB. A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). Pain Manag Nurs 2020; 21:502-509. [DOI: 10.1016/j.pmn.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
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Palliative care needs and utilization of specialist services for people imminently dying with dementia: A national population-based study. Int J Nurs Stud 2020; 109:103655. [DOI: 10.1016/j.ijnurstu.2020.103655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023]
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Bullock L, Chew-Graham CA, Bedson J, Bartlam B, Campbell P. The challenge of pain identification, assessment, and management in people with dementia: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101040. [PMID: 32457099 PMCID: PMC7330220 DOI: 10.3399/bjgpopen20x101040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia. AIM To explore pain identification, assessment, and management for community-dwelling people with dementia. DESIGN & SETTING A qualitative study was undertaken, set in England. METHOD Semi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically. RESULTS Interviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain. CONCLUSION Identifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.
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Affiliation(s)
- Laurna Bullock
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
| | - John Bedson
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Bernadette Bartlam
- School of Primary Community and Social Care, Keele University, Keele, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University Singapore, Singapore, UK
| | - Paul Campbell
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
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Amspoker AB, Snow AL, Renn BN, Block P, Pickens S, Morgan RO, Kunik ME. Patient Versus Informal Caregiver Proxy Reports of Pain Interference in Persons With Dementia. J Appl Gerontol 2020; 40:414-422. [PMID: 32026743 DOI: 10.1177/0733464820902632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors complicating assessment. Pain in Dementia As one ages, the risk of developing both dementia and pain increases substantially (Scherder et al., 2009). It is estimated that 30% to 50% of persons with dementia (PWDs) experience persistent pain, a complex multifactor problem (Corbett et al., 2014). Despite the high prevalence of pain among older adults with dementia, and major advances in pain management, pain often remains unrecognized or undertreated (Hodgson et al., 2014).
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Affiliation(s)
- Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - A Lynn Snow
- The University of Alabama, Tuscaloosa, USA.,Tuscaloosa VA Medical Center, AL, USA
| | | | | | - Sabrina Pickens
- The University of Texas Health Science Center at Houston, USA
| | - Robert O Morgan
- The University of Texas School of Public Health, Houston, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Bullock L, Bedson J, Jordan JL, Bartlam B, Chew-Graham CA, Campbell P. Pain assessment and pain treatment for community-dwelling people with dementia: A systematic review and narrative synthesis. Int J Geriatr Psychiatry 2019; 34:807-821. [PMID: 30724409 DOI: 10.1002/gps.5078] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 01/26/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the current literature on pain assessment and pain treatment for community-dwelling people with dementia. METHOD A comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full-text articles were sequentially screened. Standardised data extraction and quality appraisal exercises were conducted. RESULTS Thirty-two studies were included in the review, 11 reporting findings on pain assessment tools or methods and 27 reporting findings on treatments for pain. In regard to pain assessment, a large proportion of people with moderate to severe dementia were unable to complete a self-report pain instrument. Pain was more commonly reported by informal caregivers than the person with dementia themselves. Limited evidence was available for pain-focused behavioural observation assessment. In regard to pain treatment, paracetamol use was more common in community-dwelling people with dementia compared with people without dementia. However, non-steroidal anti-inflammatory drugs (NSAIDs) were used less. For stronger analgesics, community-dwelling people with dementia were more likely to receive strong opioids (eg, fentanyl) than people without dementia. CONCLUSION This review identifies a dearth of high-quality studies exploring pain assessment and/or treatment for community-dwelling people with dementia, not least into non-pharmacological interventions. The consequences of this lack of evidence, given the current and projected prevalence of the disease, are very serious and require urgent redress. In the meantime, clinicians should adopt a patient- and caregiver-centred, multi-dimensional, longitudinal approach to pain assessment and pain treatment for this population.
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Affiliation(s)
- Laurna Bullock
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - John Bedson
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Joanne L Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Bernadette Bartlam
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
| | - Carolyn A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Midlands Partnership NHS Foundation Trust, St George's Hospital, UK
| | - Paul Campbell
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Midlands Partnership NHS Foundation Trust, St George's Hospital, UK
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Lin PC, Li CH, Chou PL, Chen YM, Lin LC. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res 2018; 11:1589-1598. [PMID: 30214270 PMCID: PMC6126483 DOI: 10.2147/jpr.s172875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purposes To investigate the prevalence of pain-related diagnoses in patients with dementia and evaluate the association of pain-related diagnoses with demographic characteristics and dementia subtypes. Patients and methods In this population-based retrospective cohort study, participants were recruited from a cohort of 2 million people randomly sampled from the general population in the National Health Insurance Research Database of Taiwan from 2000 to 2013. The index year was defined as the period of 1 year from the date of the first diagnosis of dementia. Results The study group comprised 28,450 patients with the dementia subtypes of vascular dementia, Alzheimer’s disease, or other dementia subtypes. The mean age of patients with dementia was 76.75 years. Of all patients with dementia, 49.07% had at least one pain-related diagnosis documented in their outpatient or inpatient claim records within the index year. The top three pain-related diagnoses were osteoarthritis (29.27%), headache (12.53%), and osteoporosis (11.43%). Musculoskeletal diagnosis was more likely in female patients with vascular dementia. Although patients with vascular dementia had a significantly lower prevalence of pain-related diagnosis, they had a significantly higher risk of 1-year mortality than patients with other dementia subtypes. Conclusion During the index year, 49.07% of patients with dementia had at least one pain-related diagnosis. To investigate the differences of the use of pain medication in patients with different dementia subtypes and the difference of pain-related diagnosis and treatment in patients with and without dementia, future studies are recommended.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Mei Chen
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,International Medical Service Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan,
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Timmons S, O'Shea E, O'Neill D, Gallagher P, de Siún A, McArdle D, Gibbons P, Kennelly S. Acute hospital dementia care: results from a national audit. BMC Geriatr 2016; 16:113. [PMID: 27245979 PMCID: PMC4886443 DOI: 10.1186/s12877-016-0293-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/27/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. METHODS Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. RESULTS Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). CONCLUSION Dementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted.
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Affiliation(s)
- Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Emma O'Shea
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
| | - Paul Gallagher
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Anna de Siún
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Denise McArdle
- Quality and Patient Safety Audit Services, Health Service Executive, Dublin, Ireland
| | - Patricia Gibbons
- Quality and Patient Safety Audit Services, Health Service Executive, Dublin, Ireland
| | - Sean Kennelly
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
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