Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review

Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed-methods systematic review

AIM

To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia.

BACKGROUND

People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive.

METHODS

A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach.

RESULTS

Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care.

CONCLUSION

Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers.

RELEVANCE TO CLINICAL PRACTICE

Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed.

REPORTING METHOD

The review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No.

2024 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

[Current status of requirements in the design of healthcare facilities to ensure accessibility for patients with disabilities]

BACKGROUND AND OBJECTIVE

People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions.

MATERIALS AND METHODS

A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase).

RESULTS

Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings.

CONCLUSIONS

The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.

Italian Dementia-Friendly Hospital Trial (IDENTITÀ): efficacy of a dementia care intervention for hospital staff

This study investigated the short-term impact and the retention of a dementia care intervention for healthcare staff working in an Italian acute hospital setting. Additionally, we identified the predictors of improvement across the intervention. Sixty-two healthcare staff from an Italian public hospital participated in a dementia care intervention consisting of 5 modules delivered in a 5-hour training program focusing on dementia management, knowledge, and care. A pre-test/post-test and six-months follow-up design was used to evaluate participants' changes in knowledge, attitudes, and confidence in dementia. The intervention significantly improved healthcare staff's dementia knowledge and confidence immediately after the end of the intervention. No significant changes were observed from post-test to follow-up, indicating retention of these outcomes over six months. Regarding attitude to dementia, we found an immediate improvement only in the Recognition of Personhood scale. Looking at the predictors of improvement, healthcare staff with lower levels of knowledge, attitudes, and confidence in dementia at pre-test were those who improved more following the intervention. These findings provide further evidence that dementia care interventions are suitable initiatives to promote knowledge and skills required to manage the needs of people with dementia in an acute hospital setting.