A systematic review of specialist inpatient dementia care services versus standard inpatient dementia care in acute hospitals

B M S Mccausland,K Loughran,D S Baldwin,H P Patel,V C Osman-Hicks,J Amin

doi:10.1007/s40520-018-1021-y

Abstract

BackgroundSpecialist inpatient dementia units (SIDU) have been developed to address adverse outcomes often experienced by people living with dementia admitted to acute hospitals. However, the evidence base of their effectiveness remains limited.AimTo review the current literature to establish the comparative effectiveness of acute hospital SIDU vs. standard ward care (SWC).MethodsWe did an online search of 12 biomedical databases from inception to 31st October 2017. Studies of inpatients with any form of dementia in acute hospitals, published in English language peer-reviewed journals, using experimental, observational or qualitative study designs, comparing SIDU with SWC and which measured any qualitative or quantitative outcome of the patient or carer experience were included in the search criteria. We used a standardised data extraction and appraisal form.ResultsThree of 46 full-text studies evaluated were suitable for analysis. Due to study heterogeneity, pooled odds ratios were only possible for mortality [OR 1.06 (CI 1.0–1.4)]. Otherwise, a narrative synthesis was performed. Although quantitative measures of length of stay, mortality and behavioural and psychiatric symptoms of dementia are not significantly lower, SIDU are associated with greater patient and carer satisfaction, reduced readmission rates, more accurate and comprehensive assessment processes, documentation of resuscitation decisions, and increased rates of discharge to the patient’s own home.ConclusionsAlthough SIDU may be associated with improved care outcomes, the current evidence of their effectiveness is markedly limited. Further research and service evaluation of SIDU as a method for providing high-quality dementia care in acute NHS Trusts is needed. PROSPERO: CRD42017078364.

Highlights

Dementia represents a significant and increasing health and social care problem in the context of an ageing population [1, 2]
There is little consistent evidence that Specialist inpatient dementia units (SIDU) are superior to standard ward care (SWC), this more person-focused form of clinical care for people with dementia appears to be associated with greater patient and carer satisfaction, possible reduced readmission rates, more accurate history taking and documentation of resuscitation decisions and increased rates of discharge to the patients’ own home
Mortality data was comparable, SIDU may represent a higher quality model of care for patients living with dementia

Summary

Introduction

Dementia represents a significant and increasing health and social care problem in the context of an ageing population [1, 2]. Acute hospital admission for patients living with dementia is associated with adverse outcomes from increased length of stay (LOS), morbidity and mortality [6]. Specialist inpatient dementia units (SIDU) have been developed to address adverse outcomes often experienced by people living with dementia admitted to acute hospitals. Studies of inpatients with any form of dementia in acute hospitals, published in English language peer-reviewed journals, using experimental, observational or qualitative study designs, comparing SIDU with SWC and which measured any qualitative or quantitative outcome of the patient or carer experience were included in the search criteria. Quantitative measures of length of stay, mortality and behavioural and psychiatric symptoms of dementia are not significantly lower, SIDU are associated with greater patient and carer satisfaction, reduced readmission rates, more accurate and comprehensive assessment processes, documentation of resuscitation decisions, and increased rates of discharge to the patient’s own home.

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