Dementia Care In Acute Hospitals Research Articles

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.

175A Novel Pathway to Improve Dementia Care in Acute Hospitals may Require Specialist Nurse Support to Achieve Practice Change

175A Novel Pathway to Improve Dementia Care in Acute Hospitals may Require Specialist Nurse Support to Achieve Practice Change

Development Process of the Japan Academy of Gerontological Nursing 2016 Position Paper “Advocating for Older Adults with Dementia in Acute Care Hospitals”

Development Process of the Japan Academy of Gerontological Nursing 2016 Position Paper “Advocating for Older Adults with Dementia in Acute Care Hospitals”

Challenges of Nursing for Elderly with Dementia in Acute Care Hospitals

Challenges of Nursing for Elderly with Dementia in Acute Care Hospitals

Acute hospital dementia care: results from a national audit.

BackgroundAdmission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland.MethodsAcross all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days.ResultsMost patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001).ConclusionDementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted.

Impact of dementia on length of stay and costs in acute care hospitals

The treatment of patients with dementia in acute care hospitals is becoming increasingly more important. The aim of this study was to investigate and demonstrate aspects of the healthcare situation and resource consumption of dementia patients during their hospital stay in a ward for internal medicine. Secondary data from a ward of internal medicine were analyzed on a retrospective and case-related basis. For 100 patients a diagnosis of dementia by a general practitioner before hospitalization was identified. The control group was selected by age and sex from the other patients in the ward (n= 100). The costs were calculated on the basis of the German diagnosis-related groups (G-DRG) flat rate case classification. The relationship between dementia, deviation from the average length of stay and costs was investigated under the control of comorbidities using multivariate regression analysis. Patients with dementia had poorer health at admission with respect to functionality and orientation and a higher risk of falls and pressure ulcers. During hospitalization patients with dementia fell more frequently than patients without dementia (12 % versus 3 %, p= 0.029). Regarding the average length of stay, according to the G‑DRG catalogue patients with dementia stayed 1.4 days longer in hospital than patients without dementia and caused excess costs of 19 %. Patients with dementia are a highly vulnerable patient group with a higher consumption of resources than patients without dementia. The results demonstrate the care-related and economic consequences, which the increasing number of patients with dementia could have in the future.

Enabling hospital staff to care for people with dementia.

This is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.

Improving the hospital environment for people with dementia.

This article is the third in a series presenting examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves.

Improving activity and engagement for patients with dementia.

This is the second in a short series that presents case study examples of the positive work achieved by trusts that participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Staff often think that there is insufficient time to get to know patients and carers, especially with large and challenging workloads. Combined with a lack of activities and stimulation for patients with dementia in hospital, this can result in poor engagement and a disconnect between staff and patients. To improve these relationships and give staff more time with patients, Cambridge University Hospitals NHS Foundation Trust has introduced bay nursing for patients with dementia, where one nurse is responsible for monitoring a bay alongside a healthcare assistant for an entire shift. Part of Betsi Cadwaladr University Health Board, Glan Clwyd Hospital in north Wales has focused on improving stimulation by creating an activity room with a specially trained activity worker, providing a relaxed and friendly setting where patients with dementia can take part in a range of activities and have lunch together.

Transforming dementia care in acute hospitals.

This article provides an overview of current developments to support improvements in dementia care in acute general hospital settings. It considers the urgent need for improvement along with the effectiveness of current approaches in achieving change and delivering person-centred care. The process and outcomes of a development programme carried out by the Royal College of Nursing and evaluated by the University of Worcester are described. This programme supported clinical nurse leaders in developing dementia care in nine acute general hospitals by use of an action learning approach. Recommendations are made for a more systematic approach to developing practice that considers the context and culture of acute hospital care for people with dementia. The need for investment in clinical leaders and dementia specialists who can assist improvements and support change is emphasised.

Understanding the needs of people with dementia and family carers.

This is the first in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. When a person with dementia is in hospital, poor understanding of individual needs and preferences can contribute to a lack of person-centred care. Similarly, the needs of family carers can often be overlooked and staff do not always appreciate these needs at such a stressful time. This article illustrates how three NHS trusts have addressed these issues. To help staff get to know patients with dementia, Salford Royal NHS Foundation Trust has implemented a patient passport. Similarly, The Shrewsbury and Telford Hospital NHS Trust has implemented a carer passport that overcomes the restrictions imposed by hospital visiting hours. Royal Devon and Exeter NHS Foundation Trust also focused on carers, holding a workshop to elicit feedback on what was important to them. This was a useful means of engaging with carers and helped staff to realise that even simple changes can have a significant effect.

Introduction to the transforming dementia care in hospitals series.

A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN's development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward.

Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

ObjectiveDementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan.MethodsThis was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis.ResultsIn total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital.ConclusionsThe two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted.

Experience and opinions on post-graduate dementia training in the UK: a survey of selected consultant geriatricians

people with dementia are more likely to come into contact with a geriatrician than any other hospital specialty. Whilst it is known that there are some geriatricians with a special interest in dementia, it is unclear how this group of clinicians gained experience, and what their opinions are on current training. we obtained a list of geriatricians known to have an interest in dementia care (known as dementia champions) from the British Geriatric Society Dementia and Similar Disorders Special Interest Group. We contacted 100 'dementia champions' with an invitation to respond to a questionnaire relating to their role, experience and opinions on current training in dementia within geriatric medicine. fifty-five geriatricians responded. Ninety-one per cent were consultant physicians, and 71% were not involved in outpatient diagnostic services. Fifty-six per cent reported that their experience was via clinical attachments with old age psychiatry, and 47% regarded themselves as 'self-taught'. The majority felt that current training was inadequate with a need for more structure and time spent on attachments, less geographical variation, more training at undergraduate level and throughout other specialties and better collaboration with psychiatry. this is the first survey of the views of geriatricians leading on dementia care in acute hospitals within the UK. It gives a useful insight into how they have gained their own experience, and their opinions on how training may be improved. Equipped with the right training and expertise in diagnosis and management of dementia perhaps geriatricians may feel more confident in taking a lead in dementia care.