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Storman D, Jemioło P, Sawiec Z, Swierz MJ, Antonowicz E, Bala MM, Prokop-Dorner A. Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study. J Med Internet Res 2024; 26:e51506. [PMID: 38996331 DOI: 10.2196/51506] [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: 08/02/2023] [Revised: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery. OBJECTIVE Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers. METHODS We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ2 test, and φ coefficient was used to evaluate the posts. RESULTS The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization. CONCLUSIONS Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support.
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Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | | | - Zuzanna Sawiec
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Jan Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Antonowicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
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Davey N, Connolly E, Mc Elwaine P, Kennelly SP. A Systematic Review of Falls Risk of Frail Patients with Dementia in Hospital: Progress, Challenges, and Recommendations. Clin Interv Aging 2024; 19:1127-1139. [PMID: 38948169 PMCID: PMC11214555 DOI: 10.2147/cia.s400582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 07/02/2024] Open
Abstract
This review article assesses the effectiveness and limitations of strategies to reduce falls among hospitalized older adults with frailty and dementia. It explores the efficacy of existing fall prevention strategies for a cohort that is acutely susceptible to falls and fall-related consequences. A systematic literature search was conducted across MEDLINE, Embase, CINAHL, and PsycINFO, employing Medical Subject Headings (MeSH) to identify studies on fall prevention strategies in hospitalized older adults with both dementia and frailty published from 2013 to 2023. The initial 643 records were distilled to eight articles, with Structured Interdisciplinary Bedside Rounds (SIBR) emerging as a notable intervention. SIBR demonstrated a reduction in falls by fostering improved interdisciplinary communication and care planning. However, a decline in family engagement during consecutive sessions suggests a need for strategies to sustain familial involvement. The findings advocate for patient-centered interventions that address the cognitive and functional challenges faced by this cohort of older adults. This review advocates for comprehensive and inclusive research in hospital environments to improve fall prevention strategies for frail older adults with dementia.
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Affiliation(s)
- Naomi Davey
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Eimear Connolly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Paul Mc Elwaine
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Abowari-Sapeh ME, Ackah JA, Murphy JL, Akudjedu TN. Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review. J Med Imaging Radiat Sci 2024; 55:307-319. [PMID: 38365469 DOI: 10.1016/j.jmir.2024.01.008] [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: 10/20/2023] [Revised: 11/24/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. METHOD An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis. RESULT Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD. DISCUSSION This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments. CONCLUSION The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.
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Affiliation(s)
- Mendes E Abowari-Sapeh
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK; Oncology Department, Research & Development Unit, Royal Cornwall Hospital, Truro, UK
| | - Joseph A Ackah
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK
| | - Jane L Murphy
- Faculty of Health and Social Sciences, Ageing and Dementia Research Centre, Bournemouth University, UK
| | - Theophilus N Akudjedu
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK.
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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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Brigden TV, Mitchell C, Kuberska K, Hall A. A Principle-Based Approach to Visual Identification Systems for Hospitalized People with Dementia. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10315-x. [PMID: 38019420 DOI: 10.1007/s11673-023-10315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023]
Abstract
A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier.
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Affiliation(s)
- T V Brigden
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England.
| | - C Mitchell
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
| | - K Kuberska
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
| | - A Hall
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
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Karmarkar AM, Roy I, Lane T, Shaibi S, Baldwin JA, Kumar A. Home health services for minorities in urban and rural areas with Alzheimer's and related dementia. Home Health Care Serv Q 2023; 42:265-281. [PMID: 37128943 DOI: 10.1080/01621424.2023.2206368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01-1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12-1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03-1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Amit Kumar
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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Karmarkar AM, Roy I, Rivera-Hernandez M, Shaibi S, Baldwin JA, Lane T, Kean J, Kumar A. Examining the role of race and quality of home health agencies in delayed initiation of home health services for individuals with Alzheimer's disease and related dementias (ADRD). Alzheimers Dement 2023; 19:4037-4045. [PMID: 37204409 PMCID: PMC10730234 DOI: 10.1002/alz.13139] [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: 12/07/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION We examined differences in the timeliness of the initiation of home health care by race and the quality of home health agencies (HHA) among patients with Alzheimer's disease and related dementias (ADRD). METHODS Medicare claims and home health assessment data were used for the study cohort: individuals aged ≥65 years with ADRD, and discharged from the hospital. Home health latency was defined as patients receiving home health care after 2 days following hospital discharge. RESULTS Of 251,887 patients with ADRD, 57% received home health within 2 days following hospital discharge. Black patients were significantly more likely to experience home health latency (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.11-1.19) compared to White patients. Home health latency was significantly higher for Black patients in low-rating HHA (OR = 1.29, 95% CI = 1.22-1.37) compared to White patients in high-rating HHA. DISCUSSION Black patients are more likely to experience a delay in home health care initiation than White patients.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jacob Kean
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amit Kumar
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
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Kuberska K, Dixon‐Woods M, Martin G. Visual identifier systems for patients with cognitive impairment in healthcare settings: A survey of practice in UK hospitals. Int J Older People Nurs 2022; 17:e12472. [PMID: 35576107 PMCID: PMC9786885 DOI: 10.1111/opn.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND People with dementia and other forms of cognitive impairment form a substantial proportion of patients admitted to hospitals, but problems in their care are persistent. One widely proposed improvement approach involves the use of systems using visual identifiers to help staff quickly recognise people with suspected dementia, with the goal of supporting more personalised care. The aim of this paper is to identify the identifier systems in use and staff perceptions of their strengths and weaknesses. METHODS We undertook an online survey of staff providing care for people with dementia in acute and mental health hospitals across the United Kingdom. The questionnaire covered different types of visual identifier systems for dementia. It used categorical and open-response questions to access staff views of their use in practice. Responses were analysed using descriptive statistics, and the Framework approach for free-text answers. RESULTS 162 responses were received from staff in at least 48 hospitals. Of these, 128 had direct experience of using visual identifier systems. They reported that multiple identifier systems are in use, including schemes with national scope and locally developed approaches. Most respondents reported that more than one system is in use in their hospital. Different types of identifier were seen to have different strengths and weaknesses. Respondents had a broadly positive view of identifiers, but highlighted risks including lack of reliable and consistent use (linked to competing pressures on staff time), lack of staff training, uncertainty about patient and family views, and unclear consent processes. CONCLUSIONS Our study suggests that a wide range of identifier systems is in use in UK hospitals, with many hospitals using more than one. Further consideration should be given to ensuring that multiple perspectives-including those of patients and carers-are drawn on in optimising their design, resolving ethical issues and supporting implementation.
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Affiliation(s)
- Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
| | - Mary Dixon‐Woods
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
| | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
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Wang X, Ezeana CF, Wang L, Puppala M, Huang Y, He Y, Yu X, Yin Z, Zhao H, Lai EC, Wong STC. Risk factors and machine learning model for predicting hospitalization outcomes in geriatric patients with dementia. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12351. [PMID: 36204350 PMCID: PMC9520763 DOI: 10.1002/trc2.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022]
Abstract
Introduction Geriatric patients with dementia incur higher healthcare costs and longer hospital stays than other geriatric patients. We aimed to identify risk factors for hospitalization outcomes that could be mitigated early to improve outcomes and impact overall quality of life. Methods We identified risk factors, that is, demographics, hospital complications, pre‐admission, and post‐admission risk factors including medical history and comorbidities, affecting hospitalization outcomes determined by hospital stays and discharge dispositions. Over 150 clinical and demographic factors of 15,678 encounters (8407 patients) were retrieved from our institution's data warehouse. We further narrowed them down to twenty factors through feature selection engineering by using analysis of variance (ANOVA) and Glmnet. We developed an explainable machine‐learning model to predict hospitalization outcomes among geriatric patients with dementia. Results Our model is based on stacking ensemble learning and achieved accuracy of 95.6% and area under the curve (AUC) of 0.757. It outperformed prevalent methods of risk assessment for encounters of patients with Alzheimer's disease dementia (ADD) (4993), vascular dementia (VD) (4173), Parkinson's disease with dementia (PDD) (3735), and other unspecified dementias (OUD) (2777). Top identified hospitalization outcome risk factors, mostly from medical history, include encephalopathy, number of medical problems at admission, pressure ulcers, urinary tract infections, falls, admission source, age, race, anemia, etc., with several overlaps in multi‐dementia groups. Discussion Our model identified several predictive factors that can be modified or intervened so that efforts can be made to prevent recurrence or mitigate their adverse effects. Knowledge of the modifiable risk factors would help guide early interventions for patients at high risk for poor hospitalization outcome as defined by hospital stays longer than seven days, undesirable discharge disposition, or both. The interventions include starting specific protocols on modifiable risk factors like encephalopathy, falls, and infections, where non‐existent or not routine, to improve hospitalization outcomes of geriatric patients with dementia. Highlights A total 15,678 encounters of Geriatrics with dementia with a final 20 risk factors. Developed a predictive model for hospitalization outcomes for multi‐dementia types. Risk factors for each type were identified including those amenable to interventions. Top factors are encephalopathy, pressure ulcers, urinary tract infection (UTI), falls, and admission source. With accuracy of 95.6%, our ensemble predictive model outperforms other models.
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Affiliation(s)
- Xin Wang
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Chika F. Ezeana
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Lin Wang
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Mamta Puppala
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | | | - Yunjie He
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Xiaohui Yu
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Zheng Yin
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Hong Zhao
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
| | - Eugene C. Lai
- Neurological Institute Houston Methodist Hospital Houston Texas USA
| | - Stephen T. C. Wong
- T.T. & W.F. Chao Center for BRAIN Houston Methodist Academic Institute Houston Methodist Hospital Houston Texas USA
- Brain and Mind Research Institute Weill Cornell Medical College New York USA
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Petty S, Griffiths A, Coleston DM, Dening T. Improving emotional well-being for hospital-based patients with dementia. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-05-2020-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting.
Design/methodology/approach
A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis.
Findings
Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes.
Research limitations/implications
The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research.
Originality/value
In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.
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Røsvik J, Rokstad AMM. What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature. BMC Health Serv Res 2020; 20:723. [PMID: 32767987 PMCID: PMC7412803 DOI: 10.1186/s12913-020-05618-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment. CONCLUSION The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.
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Affiliation(s)
- Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway.
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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12
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Brunn M, Diefenbacher A, Volpe-Gillot L. Psychiatrists and neurologists in dementia care: Professionalism, practice, and perspectives. Gen Hosp Psychiatry 2020; 64:105-107. [PMID: 32067822 DOI: 10.1016/j.genhosppsych.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Brunn
- Université de Montpellier, Université de Montpellier, CEPEL, CNRS, 39 rue de l'Université, 34060 Montpellier, France.
| | - Albert Diefenbacher
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Herzbergstraße 79, 10365 Berlin, Germany.
| | - Lisette Volpe-Gillot
- Hôpital Leopold Bellan, Service de Neuro-Psycho-Gériatrie, 185 C, rue Raymond-Losserand, 75014 Paris, France.
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13
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Petty S, Dening T, Griffiths A, Coleston DM. Importance of personal and professional experience for hospital staff in person-centred dementia care: a cross-sectional interview study using freelisting in a UK hospital ward. BMJ Open 2019; 9:e025655. [PMID: 31048438 PMCID: PMC6502240 DOI: 10.1136/bmjopen-2018-025655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/23/2018] [Accepted: 01/30/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To detail how hospital staff with differing personal and professional caregiving experiences approach the care of patients with dementia, in order to make practical recommendations for practice. DESIGN Cross-sectional qualitative interviews. SETTING A UK hospital ward providing dementia care. PARTICIPANTS A complete hospital ward staff team, constituting 47 hospital staff from 10 professions. METHODS Hospital staff were asked to list their approaches to emotion-focused care in individual, ethnographic freelisting interviews. Cultural consensus analysis was used to detail variations in approaches to dementia care between staff subgroups. MAIN OUTCOME MEASURES The most salient listed descriptions of care emphasised by staff members with personal experience of dementia caregiving when compared with staff members without such experience, and descriptions from staff newer to the profession compared with staff with more years of professional dementia caregiving experience. RESULTS Subgroups of hospital staff showed different patterns of responses both in how they noticed the emotional distress of patients with dementia, and in prioritised responses that they deemed to work. Hospital staff with professional experience of dementia caregiving and staff with fewer years of professional experience prioritised mutual communication and getting to know each patient. CONCLUSIONS Subgroups of hospital staff with personal caregiving experiences and fewer years of professional care experience were more likely to describe person-centred care as their routine ways of working with patients with dementia. It is recommended that personal experience and the novice curiosity of hospital staff be considered as valuable resources that exist within multidisciplinary staff teams that could enhance staff training to improve the hospital care for patients with dementia.
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Affiliation(s)
- Stephanie Petty
- Specialist Older Adults Psychology, The Retreat, York, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Donna Maria Coleston
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Petty S, Dening T, Griffiths A, Coleston DM. Meeting the Emotional Needs of Hospital Patients With Dementia: A Freelisting Study With Ward Staff. THE GERONTOLOGIST 2018; 60:155-164. [DOI: 10.1093/geront/gny151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stephanie Petty
- The Retreat, York
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Donna Maria Coleston
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
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15
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Brooke J, Ojo O. Elements of a sustainable, competent, and empathetic workforce to support patients with dementia during an acute hospital stay: A comprehensive literature review. Int J Health Plann Manage 2017; 33:e10-e25. [PMID: 28836694 DOI: 10.1002/hpm.2448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022] Open
Abstract
Internationally, there has been a focus on the development of acute hospital workforces to support and care for people with dementia. Recommendations and initiatives to improve person-centred care in acute hospitals have included: education and training, dementia-specific roles, clinical leads, and environment changes. The aim of this literature review is to understand the elements of a sustainable, competent, and empathetic acute hospital workforce providing person-centred care for patients with dementia. The following databases were searched for literature published in English from January 1, 2006, to August 1, 2016: CINHAL, MEDLINE, PsychINFO, PubMed, and Science Direct. A thematic analysis was applied to develop a meta-synthesis of the data. A total of 12 papers with a range of methodological approaches from various countries were included. Emergent themes were as follows: understanding the current workforce, implementation and evaluation of training, and exploration of new and existing roles. An important element was the sustainability of acute hospital workforces competent in dementia care, as studies highlighted an ageing nursing population and a high turnover of staff. Dementia awareness training was sustainable, although there was a lack of consistency in the length, content, and delivery, which had a viable impact on the provision of empathetic and person-centred care. The lack of consistency of training and specialist dementia roles restricts recommendations from a robust evidence base.
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Affiliation(s)
- Joanne Brooke
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, The Colonnade, Gipsy Lane Campus, Oxford, UK
| | - Omorogieva Ojo
- Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London, UK
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16
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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