Abstract
BackgroundOlder general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment).MethodsA cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients’ cognitive status.ResultsCare challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations.ConclusionThe findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.
Highlights
Adverse events and other care complications may render hospital stays of older adults distressing and lead to serious consequences, for the patients themselves and for their relatives and hospital staff [9]
On the specific days of survey 2534 patients aged 65 years or older were registered on the visited wards: 380 patients could not be asked for participation as they were isolated, repeatedly not present, in a critical condition or out of other reasons and 685 patients refused participation or their legal representative refused or could not be reached
With respect to the study aims it was found that the prevalence rate of one or more reported care challenge(s) in older general hospital patients was 42.0%
Summary
Adverse events (e.g. falls) and other care complications (e.g. noncompliant behavior) may render hospital stays of older adults distressing and lead to serious consequences, for the patients themselves and for their relatives and hospital staff [9]. Wandering, activity disturbances, aggression, sleep disturbances, and fending off help with eating showed a significant impact on staff daily routines [28, 29] The relevance of these problems seems to increase in the presence of cognitive impairment [13, 28, 32]. Those with cognitive impairment, frequently experience adverse events and other care complications during their stay As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations
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