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Nicoli EM, Silva FVCE, Assad LG, Cardinelli CC, Alves RA, de Oliveira SG. Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review. Rev Bras Enferm 2024; 77:e20230180. [PMID: 39045975 PMCID: PMC11259443 DOI: 10.1590/0034-7167-2023-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/24/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.
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Affiliation(s)
- Esther Mourão Nicoli
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Raquel Azevedo Alves
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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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.
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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
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Resnick B, Boltz M, Galik E, Kuzmik A, Drazich BF, McPherson R, Wells CL. Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia. Am J Crit Care 2023; 32:264-274. [PMID: 37391379 DOI: 10.4037/ajcc2023440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. OBJECTIVE To explore factors associated with participation in function-focused care in this patient population. METHODS This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing. RESULTS The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14. CONCLUSION For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.
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Affiliation(s)
- Barbara Resnick
- Barbara Resnick is a professor at the University of Maryland School of Nursing, Baltimore
| | - Marie Boltz
- Marie Boltz is a professor at Penn State University, University Park, Pennsylvania
| | - Elizabeth Galik
- Elizabeth Galik is a professor at the University of Maryland School of Nursing, Baltimore
| | - Ashley Kuzmik
- Ashley Kuzmik is a postdoctoral student at Penn State University, University Park, Pennsylvania
| | - Brittany F Drazich
- Brittany F. Drazich is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Rachel McPherson
- Rachel McPherson is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Chris L Wells
- Chris L. Wells is a physical therapist at the University of Maryland Medical System, Baltimore
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4
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Is There a Role for Medication in Managing Delirium with Dementia? Geriatrics (Basel) 2022; 7:geriatrics7050114. [PMID: 36286217 PMCID: PMC9602311 DOI: 10.3390/geriatrics7050114] [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: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
People with dementia are more likely to develop delirium. We conducted a brief literature search and give a pragmatic overview of the key issues. Making rational and safe prescribing decisions is highly influenced by organisational culture and embedded staff practices. Comprehensive assessment for unmet physical, psychological, and social needs is an important intervention in itself. Taking a broad overview of possible pharmacological interventions should include stopping inappropriate medications and prescribing for key drivers of the underlying causes of delirium. Prescribing psychotropic medications may be indicated where there is significant distress or risk to the person with dementia and risk to those around them. It is vital to consider the dementia subtype and, where possible, involve family and friend carers in the decision-making process. Medications should be prescribed at the lowest possible dose for the least amount of time after carefully weighing risks versus benefits and documenting these. While these cases are challenging for staff and families, it can be rewarding to improve the quality of life and lessen distress for the person with dementia. There are also opportunities for informing family and friend carers, educating the wider multidisciplinary team, and promoting organisational change.
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Schumacher-Schönert F, Wucherer D, Nikelski A, Kreisel S, Vollmar HC, Hoffmann W, Thyrian JR. [Discharge management in German hospitals for cognitively impaired, older people-a scoping review]. Z Gerontol Geriatr 2021; 54:695-703. [PMID: 32383064 PMCID: PMC8551109 DOI: 10.1007/s00391-020-01732-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In German hospitals approximately 40% of all patients over the age of 65 years are cognitively impaired (MmkB). After discharge from hospital it is particularly important for MmkB that the transition to domestic life is organized as seamlessly and as well-coordinated as possible. OBJECTIVE The aim of the study was to determine the existing evidence on discharge management (EM) in MmkB and people with dementia (MmD). Furthermore, the study examined the necessity of an intersectoral concept for MmkB. MATERIAL AND METHODS Based on a scoping review a total of 102 publications were identified, of which 6 articles were finally used for the evaluation. RESULTS The article provides an overview of the current care of MmkB in acute care hospitals in Germany. General information on EM in hospitals was given in three of the six publications included. Information on special discharge and care management for MmkB and MmD was contained in five out of six papers. DISCUSSION The article illustrates significant gaps in the hospital care for older MmkB, in particular at the interface of discharge management and demonstrates the need for new care models. To what extent these new care models can be structurally, procedurally and systemically embedded in the standard care and financed, is an open and unexplored question.
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Affiliation(s)
- F Schumacher-Schönert
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland.
| | - D Wucherer
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - A Nikelski
- Evangelisches Klinikum Bethel gGmbH, Akademisches Lehrkrankenhaus, Universität Münster, Münster, Deutschland
| | - S Kreisel
- Evangelisches Klinikum Bethel gGmbH, Akademisches Lehrkrankenhaus, Universität Münster, Münster, Deutschland
| | - H C Vollmar
- Abteilung für Allgemeinmedizin, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Hoffmann
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - J R Thyrian
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
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Dasgupta M, Beker L, Schlegel K, Hillier LM, Joworski L, Crunican K, Coulter C. A Non-Pharmacologic Approach to Manage Behaviours in Confused Medically Ill Older Adults in Acute Care. Can Geriatr J 2021; 24:125-137. [PMID: 34079606 PMCID: PMC8137457 DOI: 10.5770/cgj.24.469] [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] [Indexed: 11/22/2022] Open
Abstract
Background Non-pharmacological interventions are recommended to manage challenging behaviours among cognitively impaired older adults, however few studies have enrolled patients in acute care. This study aimed to determine the feasibility of implementing non-pharmacological interventions to manage behaviours in hospitalized older adults. Method A self-identity approach was used to identify potentially engaging activities for 13 older medically ill adults admitted to acute hospital; these activities were trialed for a two-week period. Data were collected on frequency of intervention administration and assistance required, as well as frequency of behaviours and neuroleptic use in the seven days prior to and following the trial of activities. Results Per participant, 5–11 interventions were prescribed. Most frequently interventions were tried two or more times (46%); 9% were not tried at all. Staff or family assistance was not required for 27% of activities. The mean number of documented behaviours across participants was 4.8 ± 2.3 in the pre-intervention period and 2.1 ± 1.9 in the post-intervention period. Overall the interventions were feasible and did not result in increasing neuroleptic use Conclusion Non-pharmacologic interventions may be feasible to implement in acute care. More research in this area is justified.
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Affiliation(s)
- Monidipa Dasgupta
- Division of Geriatric Medicine, Shulich School of Medicine, Western University, London, ON.,Lawson Health Research Institute, London, ON
| | | | - Kim Schlegel
- London Health Sciences Centre, London, ON.,Fanshawe College, London, ON
| | - Loretta M Hillier
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON
| | | | | | - Corrine Coulter
- Department of Family Medicine, Shulich School of Medicine, Western University, London, ON
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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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Schnabel EL, Wahl HW, Schönstein A, Frey L, Draeger L. Nurses' emotional tone toward older inpatients: Do cognitive impairment and acute hospital setting matter? Eur J Ageing 2019; 17:371-381. [PMID: 32904870 DOI: 10.1007/s10433-019-00531-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The emotional tone of nurses' voice toward residents has been characterized as overly controlling and less person-centered. However, it is unclear whether this critical imbalance also applies to acutely ill older patients, who represent a major subgroup in acute hospitals. We therefore examined nurses' emotional tone in this setting, contrasting care interactions with severely cognitively impaired (CI) versus cognitively unimpaired older patients. Furthermore, we included a general versus a geriatric acute hospital to examine the role of different hospital environments. A mixed-methods design combining audio-recordings with standardized interviews was used. Audio-recorded clips of care interactions between 34 registered nurses (M age = 38.9 years, SD = 12.3 years) and 92 patients (M age = 83.4 years, SD = 6.1 years; 50% with CI) were evaluated by 12 naïve raters (M age = 32.8 years, SD = 9.3 years). Based on their impressions of the vocal qualities, raters judged nurses' emotional tone by an established procedure which allows to differentiate between a person-centered and a controlling tone (Cronbach's α = .98 for both subscales). Overall, findings revealed that nurses used rather person-centered tones. However, nurses' tone was rated as more controlling for CI patients and in the geriatric hospital. When controlling for patients' functional status, both effects lost significance. To our knowledge, this is the first study that examined nurses' emotional tone in the acute hospital setting. Findings suggest that overall functional status of older patients may play a more important role for emotional tone in care interactions than CI and setting differences.
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Affiliation(s)
- Eva-Luisa Schnabel
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Larissa Frey
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Lea Draeger
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
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9
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Sinvani L, Strunk A, Patel V, Shah S, Mulvany C, Kozikowski A, Boltz M, Pekmezaris R, Wolf-Klein G. Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study. Am J Alzheimers Dis Other Demen 2019; 34:223-230. [PMID: 30704268 PMCID: PMC10852488 DOI: 10.1177/1533317519826272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite substantial staffing and cost implications, the use of constant observation (CO) has been poorly described in the acute care setting. The purpose of this cross-sectional, multicenter, survey study was to assess hospital provider practices regarding the use of CO. Of the 543 surveys distributed, 231 were completed across 5 sites. Most respondents worked on medical units (67.5%), as nurses (49.1%); 44.8% were white; and 75.6% were female. The majority (84.2%) reported at least 1 patient/wk requiring CO. Most frequent indication for CO was dementia with agitation (60.7%), in patients older than 70 (62.3%) and predominantly by nurse assistants (93.9%). Almost half (47.3%) stated they felt pressured to discontinue CO, despite a strong perceived benefit (76%). Enhanced observation (92.6%) was most frequently used to decrease CO. Finally, 77.9% perceived that those performing CO lacked training. Our study highlights the widespread use of CO for hospitalized older adults with dementia.
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Affiliation(s)
- Liron Sinvani
- Department of Medicine, Division of Hospital Medicine, Northwell Health, New York, NY, USA
- Center of Health Innovation and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Andrew Strunk
- Department of Dermatology, Northwell Health, New York, NY, USA
| | - Vidhi Patel
- Center of Health Innovation and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Shalin Shah
- Department of Medicine, Division of Hospital Medicine, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Colm Mulvany
- Center of Health Innovation and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
| | - Andrzej Kozikowski
- Center of Health Innovation and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Marie Boltz
- College of Nursing, Penn State, University Park, PA, USA
| | - Renee Pekmezaris
- Center of Health Innovation and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Gisele Wolf-Klein
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Northwell Health, New York, NY, USA
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Möllers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry 2019; 34:8-21. [PMID: 30260050 DOI: 10.1002/gps.4993] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. METHODS A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. RESULTS Fifty-two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was -2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was -2.9 to +12.4 and -11.2 to +21.8 days, respectively. CONCLUSIONS The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Wenjia Wei
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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11
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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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12
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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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Handley M, Bunn F, Goodman C. Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open 2017; 7:e015257. [PMID: 28713073 PMCID: PMC5541590 DOI: 10.1136/bmjopen-2016-015257] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia. DESIGN A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature. ELIGIBILITY CRITERIA Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded. RESULTS Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context-mechanism-outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress. CONCLUSIONS This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes. TRIAL REGISTRATION NUMBER CRD42015017562.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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14
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Göhner A, Hüll M, Voigt-Radloff S. [Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review]. Z Gerontol Geriatr 2016; 51:169-183. [PMID: 27986999 DOI: 10.1007/s00391-016-1161-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/27/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. AIM OF THE ARTICLE To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. MATERIAL AND METHODS A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. RESULTS AND DISCUSSION A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.
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Affiliation(s)
- Anne Göhner
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Str. 88, 79106, Freiburg, Deutschland.
| | - Michael Hüll
- Klinik für Alterspsychiatrie und Psychotherapie, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Emmendingen, Universitätsklinikum Freiburg, Emmendingen, Freiburg, Deutschland
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15
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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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16
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Motzek T, Junge M, Marquardt G. [Impact of dementia on length of stay and costs in acute care hospitals]. Z Gerontol Geriatr 2016; 50:59-66. [PMID: 27090914 DOI: 10.1007/s00391-016-1040-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The treatment of patients with dementia in acute care hospitals is becoming increasingly more important. The aim of this study was to investigate and demonstrate aspects of the healthcare situation and resource consumption of dementia patients during their hospital stay in a ward for internal medicine. MATERIAL AND METHODS Secondary data from a ward of internal medicine were analyzed on a retrospective and case-related basis. For 100 patients a diagnosis of dementia by a general practitioner before hospitalization was identified. The control group was selected by age and sex from the other patients in the ward (n = 100). The costs were calculated on the basis of the German diagnosis-related groups (G-DRG) flat rate case classification. The relationship between dementia, deviation from the average length of stay and costs was investigated under the control of comorbidities using multivariate regression analysis. RESULTS Patients with dementia had poorer health at admission with respect to functionality and orientation and a higher risk of falls and pressure ulcers. During hospitalization patients with dementia fell more frequently than patients without dementia (12 % versus 3 %, p = 0.029). Regarding the average length of stay, according to the G‑DRG catalogue patients with dementia stayed 1.4 days longer in hospital than patients without dementia and caused excess costs of 19 %. CONCLUSION Patients with dementia are a highly vulnerable patient group with a higher consumption of resources than patients without dementia. The results demonstrate the care-related and economic consequences, which the increasing number of patients with dementia could have in the future.
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Affiliation(s)
- Tom Motzek
- Emmy Noether-Nachwuchsgruppe "Architektur im Demografischen Wandel", Professur für Sozial- und Gesundheitsbauten, Institut für Gebäudelehre und Entwerfen, Fakultät Architektur, Universität Dresden, Dresden, Deutschland
| | | | - Gesine Marquardt
- Emmy Noether-Nachwuchsgruppe "Architektur im Demografischen Wandel", Professur für Sozial- und Gesundheitsbauten, Institut für Gebäudelehre und Entwerfen, Fakultät Architektur, Universität Dresden, Dresden, Deutschland.
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17
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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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18
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Cognitive Impairment in Hospitalized Seniors. Geriatrics (Basel) 2016; 1:geriatrics1010004. [PMID: 31022800 PMCID: PMC6371190 DOI: 10.3390/geriatrics1010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022] Open
Abstract
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization affects cognitive function and how cognitive impairment affects hospital outcomes. Possible interventions in cognitively impaired hospitalized seniors are reviewed.
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Hoffmann VS, Neumann L, Golgert S, von Renteln-Kruse W. Pro-Active Fall-Risk Management is Mandatory to Sustain in Hospital-Fall Prevention in Older Patients--Validation of the LUCAS Fall-Risk Screening in 2,337 Patients. J Nutr Health Aging 2015; 19:1012-8. [PMID: 26624213 DOI: 10.1007/s12603-015-0662-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Prevention of in-hospital falls contributes to improvement of patient safety. However, the identification of high-risk patients remains a challenge despite knowledge of fall-risk factors. Hence, objective was to prospectively validate the performance of the LUCAS (Longitudinal Urban Cohort Ageing Study) fall-risk screening, based on routine data (fall history, mobility, mental status) and applied by nurses. DESIGN Observational study comparing two groups of patients who underwent different fall-risk screenings; the LUCAS screening (2010 - 2011) and the STRATIFY (St. Thomas's Risk Assessment Tool In Falling Elderly Inpatients) (2004 - 2006). SETTING Urban teaching hospital. PARTICIPANTS Consecutively hospitalized patients (≥ 65 years old) were screened on admission; LUCAS n = 2,337, STRATIFY n = 4,735. MEASUREMENTS The proportions of fallers were compared between the STRATIFY and the LUCAS time periods. The number of fallers expected was compared to that observed in the LUCAS time period. Standardized fall-incidence recording included case-note checks for unreported falls. Plausibility checks of fall-risk factors and logistic regression analysis for variable fall-risk factors were performed. RESULTS The proportions of fallers during the two time periods were LUCAS n = 291/2,337 (12.5%) vs. STRATIFY n = 508/4,735 (10.7%). After adjustment for risk-factor prevalence, the proportion of fallers expected was 14.5% (334/2,337), the proportion observed was 12.5% (291/2,337) (p = 0.038). CONCLUSIONS In-hospital fall prevention including systematic use of the LUCAS fall-risk screening reduced the proportion of fallers compared to that expected from the patients' fall-risk profile. Raw proportions of fallers are not suitable to evaluate fall prevention in hospital because of variable prevalence of patients' fall-risk factors over time. Continuous communication, education and training is needed to sustain in-hospital falls prevention.
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Affiliation(s)
- V S Hoffmann
- Lilli Neumann, Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany, Tel.: ++49-40-5581-1692; Fax: ++49-40-5581-1874; E-Mail:
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Takechi H, Mori T, Hashimoto T, Nakamura S. Present status and road map to achieve inclusive and holistic care for dementia in a Japanese community: analysis using the Delphi method. Dement Geriatr Cogn Disord 2015; 38:186-99. [PMID: 24732454 DOI: 10.1159/000358821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia is a priority issue in the public health realm. However, few reports address problems of dementia in the real world or provide comprehensive road maps to solve these problems. METHODS Nine groups of questions covering 4 topics were discussed using the Delphi method, relating to (1) current achievements and challenges regarding inclusive and holistic care in the community, (2) patients who are at a high risk of being excluded from care, (3) suggestions for a road map for the establishment of better and more inclusive medical and social care, and (4) unmet needs of patients with dementia. RESULTS In total, 477 opinions were obtained. Family issues, psychological/behavioral symptoms, and complications secondary to physical disorders are main factors for being excluded from care. To create a road map for care we have to address the topics of reaffirming care principles, multidisciplinary coalitions, and education for stakeholders. CONCLUSION Further effective collaboration to promote dementia care is required.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatric Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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21
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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.
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Affiliation(s)
- W Hofmann
- Deutsche Gesellschaft für Geriatrie (DGG) e. V., Kunibertskloster 11-13, 50668, Köln, Deutschland,
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Abstract
Dementia is a clinical syndrome characterized by progressive memory loss. Alzheimer's disease, a neurodegenerative disorder, accounts for the majority of clinical cases. The differential diagnosis comprises other neurodegenerative disease entities and vascular dementia, but also secondary and potentially reversible disturbances of cognitive function such as delirium or depression. Diagnostic work-up consists of standardized cognitive testing, neuroimaging, and a basic laboratory test battery. Pharmacological treatment of cognitive symptoms is accompanied by pharmacological and nonpharmacological treatment of psychiatric and behavioral symptoms, establishment of a supportive social network, as well as prevention and treatment of medical complications of dementia. This article summarizes current clinical knowledge on dementia and has a special interest in treatment and prophylaxis of complications in the field of internal medicine.
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Dewing J, Dijk S. What is the current state of care for older people with dementia in general hospitals? A literature review. DEMENTIA 2014; 15:106-24. [PMID: 24459188 DOI: 10.1177/1471301213520172] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care.
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Affiliation(s)
- Jan Dewing
- East Sussex NHS Trust & Canterbury Christ Church University, UK
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Zhang S, Cao J, Ahn C. A GEE Approach to Determine Sample Size for Pre- and Post-Intervention Experiments with Dropout. Comput Stat Data Anal 2014; 69:10.1016/j.csda.2013.07.037. [PMID: 24293779 PMCID: PMC3842849 DOI: 10.1016/j.csda.2013.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pre- and post-intervention experiments are widely used in medical and social behavioral studies, where each subject is supposed to contribute a pair of observations. In this paper we investigate sample size requirement for a scenario frequently encountered by practitioners: All enrolled subjects participate in the pre-intervention phase of study, but some of them will drop out due to various reasons, thus resulting in missing values in the post-intervention measurements. Traditional sample size calculation based on the McNemar's test could not accommodate missing data. Through the GEE approach, we derive a closed-form sample size formula that properly accounts for the impact of partial observations. We demonstrate that when there is no missing data, the proposed sample size estimate under the GEE approach is very close to that under the McNemar's test. When there is missing data, the proposed method can lead to substantial saving in sample size. Simulation studies and an example are presented.
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Affiliation(s)
- Song Zhang
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
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Sheehan B, Lall R, Gage H, Holland C, Katz J, Mitchell K. A 12-month follow-up study of people with dementia referred to general hospital liaison psychiatry services. Age Ageing 2013; 42:786-90. [PMID: 24166239 DOI: 10.1093/ageing/aft139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND new services for patients with dementia in general hospitals are being widely developed. Little is known of outcomes after hospital for such patients. OBJECTIVE to establish outcomes for patients with dementia referred to general hospital psychiatric services. DESIGN prospective cohort study. SETTING two UK general hospitals. SUBJECTS referrals with dementia to liaison psychiatric services. METHOD eligible referrals (n = 112), and their carers, were assessed during admission, and at 6 and 12 months, using battery of health measurements. RESULTS mortality at 6 months was 31% and at 12 months 40%. At baseline, 13% lived in a care home, rising to 84% by 6 months. Quality of life scores remained stable over 12 months, while carer stress fell significantly. Baseline clinical and demographic variables did not predict quality of life or carer stress at 6 and 12 months. CONCLUSIONS dementia liaison services in general hospitals currently focus on poor outcome cases.
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Affiliation(s)
- Bart Sheehan
- John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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Evaluating the prevalence of dementia in hospitalized older adults and effects of comorbid dementia on patients' hospital course. Aging Clin Exp Res 2013; 25:393-401. [PMID: 23872925 DOI: 10.1007/s40520-013-0068-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Many older adults with dementia are hospitalized for diagnoses other than dementia. We aimed to determine the prevalence of comorbid dementia among hospitalized older adults and evaluate its effects on their hospital course. METHODS This retrospective case-control study reviewed the hospital records of all adults aged over 60 years admitted to one tertiary hospital in China from 2002 to 2012. In total, 34,888 patients meeting the age criterion were included. Patients admitted to departments of pediatrics, obstetrics and gynecology were not included. Demographic, clinical and outcome data from computerized discharge records were collected. Patients diagnosed with dementia at discharge by DSM-IV-TR criteria and MMSE scores formed the dementia group. All other patients were controls. Illness rating scale, comorbidities, mortality at discharge, dementia subtypes and long-term follow-up status for dementia patients were analyzed using comparative statistical methods (e.g., one-way ANOVA with Bonferroni pairwise comparison, Kruskal-Wallis and Mann-Whitney U test pairwise comparisons). RESULTS A total of 918 patients (2.6% prevalence) had comorbid dementia, including Alzheimer's disease (39.1%) and vascular dementia (39.4%). Neurologic and respiratory system diseases were the most common main diagnoses for patients with comorbid dementia, who also had a higher percentage of level III or IV severity of main illness compared to controls and longer hospital stays (both P < 0.01). Mortality at discharge included 9.80% of the dementia group and 8.84% of controls (P = 0.312). CONCLUSION Comorbid dementia has significant effects on hospital course of older adults with various main diagnoses, affecting length of stay, severity of illness, and mortality.
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Rutledge DN, Wickman M, Drake D, Winokur E, Loucks J. Instrument validation: hospital nurse perceptions of their Behavioral Health Care Competency. J Adv Nurs 2012; 68:2756-65. [DOI: 10.1111/j.1365-2648.2012.06025.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rösler A, von Renteln-Kruse W, Mühlhan C, Frilling B. Treatment of dementia patients with fracture of the proximal femur in a specialized geriatric care unit compared to conventional geriatric care. Z Gerontol Geriatr 2012; 45:400-3. [DOI: 10.1007/s00391-012-0299-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Soto ME, Andrieu S, Villars H, Secher M, Gardette V, Coley N, Nourhashemi F, Vellas B. Improving care of older adults with dementia: description of 6299 hospitalizations over 11 years in a special acute care unit. J Am Med Dir Assoc 2012; 13:486.e1-6. [PMID: 22264688 DOI: 10.1016/j.jamda.2011.12.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe hospitalizations in a Special Acute Care inpatient Unit for older adults with Alzheimer's disease (AD) and other related disorders. DESIGN An 11-year observational study of consecutive hospitalizations from 1996 to 2006. SETTING The Alzheimer Special Acute Care inpatient Unit in the Geriatrics Department of the Toulouse University Hospital, France. PARTICIPANTS A total of 4708 patients with dementia accounting for 6299 consecutive hospitalizations. MEASUREMENTS Data regarding admission causes, cognition, physical disability, nutritional assessment, behavioral and psychological symptoms of dementia, and sociodemographics were recorded. RESULTS Data from 6299 hospitalizations are presented: 4708 (74.7%) hospitalizations accounted for first-time admissions and 1591 (25.3%) were rehospitalizations. Among the first-time admissions, complications of dementia and cognitive diagnosis experienced a significant switch in frequency. Whereas until 2001, the main cause of admission was for a diagnosis (51%), complications became the primary cause from 2003 onward with a significant increasing trend (56%) (P < .001). The most frequent cause of complications was behavioral and psychological symptoms of dementia, with a significant trend for an increased frequency (P < .001). Agitation-aggressiveness represented 60% of behavioral and psychological symptoms of dementia. Between 1996 and 2006, the age of patients at first-time admission gradually increased over time, as did the severity of cognitive impairment and the prevalence of unsatisfactory nutritional status (P for trend < .001 for each variable). CONCLUSIONS The evolving patient characteristics and the causes of first-time admissions changed over the course of 11 years. Behavioral and psychological symptoms of dementia, especially agitation-aggressiveness, have progressively become the key drivers of Special Acute Care inpatient Unit hospitalizations. These findings suggest that the role, mission, and functioning of the Special Acute Care inpatient Unit within the Alzheimer care system has been modified over time.
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Affiliation(s)
- Maria E Soto
- Department of Geriatric Medicine, Gérontopôle de Toulouse, Toulouse University Hospital, Toulouse, France.
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Improving care for people with dementia in acute hospital: the role of person‐centred assessment. QUALITY IN AGEING AND OLDER ADULTS 2011. [DOI: 10.1108/14717791111144696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rösler A, Hofmann W, von Renteln-Kruse W, Flesch P, Greuel HW, Hoffmann J, Hofmann W, Kopf D, Meyer AK, Merk B, Nehen HG, Püllen R, Schwab J, von Renteln-Kruse W, Weil K. [Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany]. Z Gerontol Geriatr 2011; 43:249-53. [PMID: 20848262 DOI: 10.1007/s00391-010-0132-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
During recent years, specialized wards have been established in geriatric hospital departments as a consequence of the growing need of special care for acutely ill older patients, who are also cognitively impaired. However, there are neither established standards nor any commonly agreed concept of care. A written survey among 12 specialized wards in Germany revealed some characteristics of these wards: extended geriatric assessment, special education of staff including validation and gerontopsychiatric issues, and particular equipment/architecture, such as hidden doors and group rooms, and in some cases loop tracks for walking, therapeutic facilities, and 'living rooms' on the wards. There is a wide variability with respect to the designation of these wards, the number of beds, length of stay, and admission criteria. It appears from this survey that there should be an exchange of empirical experience made on these wards, and there is a need of collaborative research on its usefulness.
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Affiliation(s)
- A Rösler
- Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, 22459 Hamburg.
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