Abstract
BackgroundAn increasingly high number of patients admitted to hospital have dementia. Hospital environments can be particularly confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. Improving the experience of care in hospital has been recognized as a priority, and non-pharmacological interventions including activity interventions have been associated with improved wellbeing and behavioral outcomes for Plwd in other settings. This systematic review aimed at evaluating the effectiveness of activity interventions to improve experience of care for Plwd in hospital.MethodsSystematic searches were conducted in 16 electronic databases up to October 2019. Reference lists of included studies and forward citation searching were also conducted. Quantitative studies reporting comparative data for activity interventions delivered to Plwd aiming to improve their experience of care in hospital were included. Screening for inclusion, data extraction and quality appraisal were performed independently by two reviewers with discrepancies resolved by discussion with a third where necessary. Standardized mean differences (SMDs) were calculated where possible to support narrative statements and aid interpretation.ResultsSix studies met the inclusion criteria (one randomized and five non-randomized uncontrolled studies) including 216 Plwd. Activity interventions evaluated music, art, social, psychotherapeutic, and combinations of tailored activities in relation to wellbeing outcomes. Although studies were generally underpowered, findings indicated beneficial effects of activity interventions with improved mood and engagement of Plwd while in hospital, and reduced levels of responsive behaviors. Calculated SMDs ranged from very small to large but were mostly statistically non-significant.ConclusionsThe small number of identified studies indicate that activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for Plwd. Larger well-conducted studies are needed to fully evaluate the potential of this type of non-pharmacological intervention to improve experience of care in hospital settings, and whether any benefits extend to staff wellbeing and the wider ward environment.
Highlights
An increasingly high number of patients admitted to hospital have dementia
The estimated 850,000 people living with dementia (Plwd) in the UK and over 46 million people worldwide are overrepresented in this inpatient population: approximately 25% of hospital beds are occupied by Plwd [2, 3] who often have several additional long-term conditions [4]
While 20% of hospital admissions of Plwd are potentially preventable [7] some unplanned admissions are unavoidable, and it is important that hospital care supports the needs of those affected by dementia
Summary
An increasingly high number of patients admitted to hospital have dementia. Hospital environments can be confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. The estimated 850,000 people living with dementia (Plwd) in the UK and over 46 million people worldwide are overrepresented in this inpatient population: approximately 25% of hospital beds are occupied by Plwd [2, 3] who often have several additional long-term conditions (e.g. heart disease, diabetes) [4]. Those admitted to hospital with dementia experience complications and adverse outcomes including longer length of stay, greater mortality and increased risk of institutionalization post-discharge compared to those without dementia [5, 6]. What happens in hospitals can have a profound and permanent effect on individuals and their families, in terms of their inpatient experience, and their ongoing health and the decisions that are made about their future [8, 9]
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