A systematic review of interventions to improve acute hospital care for people with dementia

Melanie Karrer,Angela Schnelli,Adelheid Zeller,Hanna Mayer

doi:10.1016/j.gerinurse.2021.03.006

Melanie Karrer, Angela Schnelli + Show 2 more

Open Access

https://doi.org/10.1016/j.gerinurse.2021.03.006

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Abstract

The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes.The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes.However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.

Highlights

Prevalence rates for dementia in the acute hospital setting vary in the literature
We included studies focussing on patients with cognitive impairment in general since the dementia diagnosis is often not known in the hospital setting 1
This systematic review provides a comprehensive overview of interventional studies and systematic reviews of interventions targeting the care situation of patients with dementia in acute care hospitals

Summary

Introduction

Prevalence rates for dementia in the acute hospital setting vary in the literature. About 20-25% of hospital patients are affected by dementia.[1,2] It might be assumed that these numbers are underestimated as about 56% of dementia cases are not diagnosed or recognised by healthcare staff. 3 In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) dementia is described as “major neurocognitive disorder”.4. The International Classification of Diseases (ICD-11) defines dementia as “acquired brain syndrome characterized by a decline from a previous level of cognitive functioning with impairment in two or more cognitive domains (such as memory, executive functions, attention, language, social cognition and judgment, psychomotor speed, visuoperceptual or visuospatial abilities)”. Cognitive impairment influences a person’s independence.[5] The psychological and social needs of persons with dementia are love, comfort, attachment, occupation, inclusion and identity.[6]

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