Abstract
Despite the increasing number of older people, many with cognitive impairment (CI), in hospitals, there is yet to be an evaluation of hospital-wide interventions improving the management of those with CI. In hospitalized patients with CI, there are likely to be associations between increased complications that impact on outcomes, length of stay, and costs. This prospective study will evaluate the effectiveness of an established hospital CI support program on patient outcomes, patient quality of life, staff awareness of CI, and carer satisfaction. Using a stepped-wedge, continuous-recruitment method, the pre-intervention patient data will provide the control data for usual hospital care. The intervention, the Dementia Care in Hospitals Program, provides hospital-wide CI awareness and support education, and screening for all patients aged 65+, along with a bedside alert, the Cognitive Impairment Identifier. The primary outcome is a reduction in hospital-acquired complications: urinary tract infections, pressure injuries, pneumonia and delirium. Secondary outcome measures include cost effectiveness, patient quality of life, carer satisfaction, staff awareness of CI, and staff perceived impact of care. This large-sample study across four sites offers an opportunity for research evaluation of health service functioning at a whole-of-hospital level, which is important for sustainable change in hospital practice.
Highlights
Dementia is the leading cause of disability burden and the second leading cause of burden of disease for people aged 65+ [1]
The Dementia Care in Hospitals Program (DCHP) provides an intervention that aims to change the hospital care paradigm from one where all hospitalized adults are expected to manage the complex demands of hospital care, to one where it is recognized that additional support and a change to the hospital processes and environment are needed for those with cognitive impairment (CI)
Patients transferred to a participating ward from a nonparticipating ward will be included if they stay on the participating ward for longer than
Summary
Dementia is the leading cause of disability burden and the second leading cause of burden of disease for people aged 65+ [1]. The diagnosis and documentation of dementia is made difficult by the presence of other causes of memory and thinking disorders, such as delirium, head injury, or narcosis. Following up an effective screening program with a process for hospital-wide awareness of patients with CI, embedded by way of a simple staff–patient communication strategy, has the potential to reduce incidence of complications, improve hospital outcomes, reduce length of stay, and lower costs. The Dementia Care in Hospitals Program (DCHP) provides an intervention that aims to change the hospital care paradigm from one where all hospitalized adults are expected to manage the complex demands of hospital care, to one where it is recognized that additional support and a change to the hospital processes and environment are needed for those with CI. Secondary aims include an economic evaluation of the intervention compared to usual hospital care, and an examination of its impact on patient quality of life, carer satisfaction, staff awareness of CI, and staff perceived burden of care when caring for patients with CI in hospital
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