Dementia Care In Acute Hospitals Research Articles

A CONCEPT ANALYSIS OF SHARED DECISION MAKING FOR OLDER PATIENTS WITH DEMENTIA IN ACUTE CARE HOSPITALS

Abstract Background Dementia patients often have comorbidities like Diabetes Mellitus, kidney disease, and cardiovascular disease that require patient decision-making about care, despite the challenges in judgment that stem from dementia. The study aimed to determine what Shared Decision-making is for older patients with dementia in acute care hospitals. Methods The study used the Hybrid Model of concept analysis method. This comprises a theoretical phase, a fieldwork phase, and an analytical phase. In the initial phase, the concept is selected. The fieldwork phase collects qualitative data to further analyze the selected concept. The third phase analyzes the empirical observations and writes up the findings. We searched Pub-Med, CINAHL, and PsycINFO for the keywords: “shared decision-making” and “patients with dementia.” Results We identified 14 articles that gave rise to over 100 codes. We defined shared decision-making for older patients with dementia in acute care hospitals as “The older person with dementia can be involved in collaborative activities in the care network, including delegation of authority as active decision-making. Open-minded communication based on person-centered care can be the foundation for considering feasible options. Clarify the role of family caregivers and identify decision-making participants in the care network to view the best alternative for the patient’s subsequent life”. Conclusions We developed a working definition of shared decision-making for patients with dementia. We clarified critical elements of the decision-making process, like based as person-centered care, open-minded communication, and collaborative decision-making activities between the person and the care network members, including delegation of authority.

254 The use of delirium screening tools during acute inpatient hospital admissions: a local audit

Abstract Background According to the ‘Second Irish National Audit of Dementia Care in Acute Hospitals (INAD-2), it is estimated that 20% of all adults admitted to hospital have a diagnosis of delirium during admission. Local HSE guidelines advise that all older adults (>65 years) should have a formalised delirium screening tool completed within the first 24 hours of presenting to the Emergency Department (ED). Methods We reviewed the medical admission documentation and subsequent medical notes in the charts of current inpatients on three Geriatric Medicine wards in the hospital. Data was collected from 56 patients over the age of 65 over a two day period. Results Data was collected from 56 patients. 21.4% (n = 12) had a delirium screening tool documented. Of those, 100% used 4AT testing and 100% were completed by the OPAL team (Older Person Assessment and Liaison Team)/ED Frailty Intervention Team. 5.4% (n = 3) met diagnostic criteria for delirium. 21.4% (n = 12) had delirium documented as a diagnosis on their medical admission, of which only 3 had delirium screening completed. 26.7% (n = 15) had a documented pre-existing diagnoses of dementia. Of those, 2 had a formal delirium screen documented. 25% (n = 14) were diagnosed with delirium later in their admission. Of those, 3 had a delirium screening tool completed at any point. The vocabulary used to describe delirium was also examined. Most commonly the words confusion (10) and agitated (4) were used instead of delirium. 4 had delirium subcategorised as hypoactive. Conclusion Delirium continues to be prevalent among our older inpatients and has been shown to be directly related to increased mortality. It is vital that we make use of the tools that are available to us to identify those at risk and those already suffering from this condition. We should prioritise appropriate delirium screening with standardised assessment tools in order to correctly identify those at risk.

Factors related to the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals

Factors related to the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals

323 A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT FOR MANAGING NON-COGNITIVE SYMPTOMS OF DEMENTIA IN ACUTE CARE

Abstract Background Over 80% of patients with dementia in acute care hospitals are prescribed an antipsychotic drug (INAD2) for management of Non-Cognitive Symptoms of Dementia (NCSD). Antipsychotics have a high side effect burden including increased mortality. Non-pharmacological interventions are first line management but many acute care wards are poorly equipped to deliver such interventions. The project aims to improve management of patients’ NCSD and reduce pro re nata (PRN)/stat and intra-muscular (IM) antipsychotic prescribing in an acute care older adult ward. Methods Using Plan-Do-Study-Act cycles (PDSA) a multicomponent intervention was iteratively designed and the implementation strategy is being tested. The components includes: an antipsychotic decision algorithm, Clinical Nurse Specialist (CNS) led patient review, patient behaviour charts, staff education and one-to-one coaching by CNS, patient ‘Get-to-Know-Me’ document and distraction resources. The evaluation involves a monthly point-prevalence audit of patient drug charts. Results Over a seven-month period, baseline data indicated wide variability in patterns of antipsychotic prescribing. A median of 14 patients per month (min 7, max 18) were prescribed an antipsychotic drug, a median of five patients (min 3, max 12) were prescribed PRN antipsychotics and a median of two patients (min1,max3) received one or more IM injection for NCSD. There was often little information on the reason for administering PRN antipsychotic medication. There was some evidence of reduced PRN and IM medication for new patient admissions (0-4 doses), but individual patients with prolonged hospital stays had high levels of antipsychotic use. Conclusion Reducing reliance on antipsychotic drugs requires multicomponent intervention and MDT collaboration. This intervention focussed primarily on coaching of healthcare professionals and improving the quality and consistency of prescribing. However, much more is required on environment design and access to cognitively stimulating activities to achieve a sustained improvement in patient outcomes, especially patients who experience a prolonged hospital stay.

Building collaborative relationships with family caregivers of hospitalized older persons with delirium superimposed on dementia: A qualitative study.

To explore experiences of family caregivers providing support to older persons with delirium superimposed on dementia in acute care hospitals, their role in detection and management of this condition, and support they require. This study has an exploratory-descriptive design using interpretive description methodology. Semi-structured interviews were conducted with nine caregivers from January to April 2020. Interview transcripts underwent thematic analysis. Three themes were identified: (1) family caregivers found delirium superimposed on dementia to be an overwhelming experience, (2) family caregivers can play an important role in the detection and management of delirium superimposed on dementia and (3) family caregivers' experiences were influenced by the nature of their relationship with the health care team. Family caregivers found the experience distressing and felt unprepared to face the condition. Family caregivers also possessed knowledge helpful in detecting acute changes and caring for the older person. Family caregivers' relationships with the health care team varied: some felt supported by the team, while others experienced a power imbalance, characterized by lack of communication and opportunities to participate in care. Family caregivers were distressed to see family members hospitalized with delirium superimposed on dementia. Family caregivers are also ideally positioned to detect the condition and participate in care. However, power imbalances remain, leaving family caregivers feeling disempowered and believing the health care team had more control over the older person's care. Findings highlight the need for strategies to address the distress and disempowerment experienced by family caregivers of hospitalized older persons with delirium superimposed on dementia. By building collaborative relationships, nurses and other health care team members can help family caregivers navigate the complex experience with delirium superimposed on dementia and reduce distress, with the ultimate goal of facilitating family caregivers' ability to care for older persons in the community. While the study participants are members of the public, this population was not involved in the study design and analysis. This method aligns with interpretive description, where researchers are not just a medium through which participants speak, but also interpretive instruments who discern insights not accessible to persons who may be familiar with only a single case.

Dementia care in acute hospitals: A framework for practice development and theory-based evaluation.

The aim was to generate a framework for dementia care in acute hospitals. Framework development with logic modelling. In phase one, we identified relevant elements of the framework by analysing several sources and by critically discussing them within the research team. We created the framework with logic modelling. In phase two, we adapted the framework in expert workshops and by reanalysing the included sources. We used the first stage of CReDECI 2 checklist for reporting. The framework describes necessary activities within four main bundles of measures: "developing structures and processes," "developing competences and attitudes," "building relationships" and "ensuring a social environment and adequate stimulation." The overarching outcome is a person-centred hospital culture, manifesting itself on different levels. The framework illustrates the necessity of an organization-wide person-centred culture for achieving positive outcomes for people with dementia, their relatives and health professionals.

Extended length of stay and related costs associated with dementia in acute care hospitals in Ireland

Objective To estimate the additional impact of dementia on in-patient length of stay (LOS) and related costs in Irish acute hospitals. Both principal and secondary diagnosis effects are estimated and valued. Methods This is a cross-sectional study based on administrative data collected on all public hospital in-patient discharges in Ireland for people aged 65 years and older in 2019. Coarsened exact matching (CEM) was undertaken to account for observed confounders between dementia and non-dementia groups, while generalised linear modelling (GLM) was used to compare differences in LOS. Results Patients with a principal diagnosis of dementia spent on average 17.5 (CI: 15.42, 19.56; p < .01) d longer in hospital than similar patients with no principal diagnosis of dementia. LOS was 6.7 (CI: 6.31, 7.14; p < .01) d longer for patients with a secondary diagnosis of dementia compared to similar patients with no secondary diagnosis of dementia. The additional annual cost of care for patients in hospitals with a secondary (principal) diagnosis of dementia was €62.0 million (€13.2 million). Conclusions This study highlights the economic impact of extended LOS for patients with dementia in Irish acute hospitals. Addressing specific dementia-related needs of people in hospital is likely to optimise resource use and decrease health care costs in acute care settings.

Current Status and Factors Related to Nursing Practice for Older Adults with Dementia in Acute Care Hospitals

Current Status and Factors Related to Nursing Practice for Older Adults with Dementia in Acute Care Hospitals

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

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.

Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study.

BackgroundAs virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals.ObjectiveThis study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia.MethodsA prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator–facilitated sessions of viewing immersive 360° VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience.ResultsAll recruited participants (N=10) completed the study. Of the 10 participants, 7 (70%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported.ConclusionsIt is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals.

Relationship Between Difficulties Felt by Nurses Caring for Elderly with Dementia in Acute Care Hospitals and Their Burnout

Relationship Between Difficulties Felt by Nurses Caring for Elderly with Dementia in Acute Care Hospitals and Their Burnout

Development of a Measurement Scale to Assess the Feeling of Difficulty in Nursing Care for Older Patients with Dementia in Acute-care Hospitals

Development of a Measurement Scale to Assess the Feeling of Difficulty in Nursing Care for Older Patients with Dementia in Acute-care Hospitals

An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

BackgroundGlobally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan.MethodsAll patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission.ResultsTwo hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03).ConclusionsThese findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

Dementia care in acute hospitals-A qualitative study on nurse managers' perceived challenges and solutions.

The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges. Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi-level factors need to be considered to promote changes in practice. Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorize the perceived challenges and solutions. The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles. This study highlight the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed. Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care.

Admiral Nursing—A Model of Specialist Dementia Care in Acute Hospitals

IntroductionThe rising prevalence of dementia has led to increased numbers of people with dementia being admitted to acute hospitals. This demand is set to continue due to an increasingly older population who are likely to have higher levels of dependency, dementia, and comorbidity. If admitted to the hospital, people with dementia are at higher risk of poor outcomes during and following a hospital admission. Yet, there remains a significant lack of specialist support within acute hospitals to support people with dementia, their families and hospital staff.MethodsAdmiral Nurses are specialists that work with families affected by dementia and provide consultancy and support to health and social care colleagues to improve the delivery of evidenced based dementia care. Historically, Admiral Nurses have predominantly been based in community settings. In response to the increasing fragmentation of services across the dementia trajectory, the Admiral Nurse model is evolving and adapting to meet the complex needs of families impacted upon by dementia inclusive of acute hospital care.ResultsThe Admiral Nurse acute hospital model provides specialist interventions which improve staff confidence and competence and enables positive change by improving skills and knowledge in the provision of person-centred dementia care. The role has the capacity to address some of the barriers to delivering person centred dementia care in the acute hospital and contribute to improvements across the hospital both as a result of direct interventions or influencing the practice of others.ConclusionImproving services for people with dementia and their families requires a whole system approach to enable care coordination and service integration, this must include acute hospital care. The increasing numbers of people with dementia in hospitals, and the detrimental effects of admission, make providing equitable, consistent, safe, quality care and support to people with dementia and their families a national priority requiring immediate investment. The inclusion of Admiral Nursing within acute hospital services supports service and quality improvement which positively impacts upon the experience and outcomes for families affected by dementia.

A qualitative focus group discussion study on the experiences of Certified Nurses in Dementia Nursing related to effective staff education.

AimTo explore the experiences of Certified Nurses in Dementia Nursing (DCNs) concerning the effective education of staff in acute hospitals.BackgroundIn Japan, the number of inpatients with dementia who need medical care continues to increase. DCNs play an important role in educating medical staff about dementia care in acute hospitals. However, there is a lack of a clear understanding in this regard.DesignA qualitative design using a thematic analysis.MethodsData were extracted from a focus group discussion conducted with 10 DCNs working in 10 different acute hospitals in central Japan. Participants answered semi‐structured, open‐ended questions about their experiences related to effective staff education. Categories, subcategories and themes were created. This study complied with the Standards for Reporting Qualitative Research.ResultsThe two themes identified were “building a foundation for dementia care education” and “continuous support based on practical processes.”

Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes

Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices. A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards. The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices. The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.

Literature Review Focusing on the Difficulties Nurses Experience in Providing Care for Elderly Patients with Dementia in Acute Care Hospitals in Japan

Literature Review Focusing on the Difficulties Nurses Experience in Providing Care for Elderly Patients with Dementia in Acute Care Hospitals in Japan

Patients with dementia in acute care hospitals : Across-sectional study of physicians' experiences and attitudes.

Patients with dementia (PwD) are avulnerable group and caring for these patients in acute care hospitals is challenging. Structural conditions and standardized treatment procedures in hospitals often do not correspond to the needs of this patient group. Physicians may not be well prepared for caring for PwD. This study aimed to ascertain physicians' experiences and attitudes in caring for PwD or cognitive disorders and their subjective workload. This describes physicians' estimation of the share of the overall workload resulting from caring for PwD on the ward. Furthermore, we identified factors that are most likely to contribute to the workload. An online survey was conducted using aself-developed standardized questionnaire with 29questions based on asystematic literature review. The questionnaire was pretested in several steps and finally sent out via e‑mail to 610 physicians in 9hospitals in northern Germany. Aspects surveyed were: physicians' confidence in caring for PwD and resulting workload, challenges in caring for PwD, collaboration with relatives and other professionals and educational needs. Important influencing factors were determined by multiple linear regression analyses. A total of 192 hospital physicians completed the questionnaire (response rate 32%). According to respondents the proportion of PwD in acute care hospitals increased significantly during the last 3 years. Only one third of respondents reported feeling confident in caring for PwD and 65% stated that they do not feel confident in caring for PwD especially in situations of nutrition in cases of food refusal and distinguishing between delirium and dementia. The strongest influencing factors were increased efforts in terms of time and support needs, complex medical situations, difficult collaboration with relatives and lack of patient compliance. Asuccessful collaboration with other professionals was associated with increased confidence in caring for PwD. Legal and ethical aspects as well as drug therapies were mentioned as desirable topics for educational programs. Arelevant number of hospital physicians feel insecure and burdened in caring for PwD. The study provides important information for the design of educational programs and for potential changes in structural and procedural aspects. The results may be used as starting points for improving hospital care for PwD.

Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals.

A national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was "use of physical restraint." Among patients, the point prevalence of physical restraint was 44.5% (n = 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]). The financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.