Dementia In Acute Care Research Articles

Associations between hospital organizational features, person-centred care and nurse-sensitive outcomes for persons with dementia in acute care: A systematic literature review.

The aim of this systematic literature review was to determine the extent and quality of quantitative evidence regarding associations between hospital organizational features, person-centred care (PCC) and nursing-sensitive outcomes among persons with dementia in the acute care setting. Systematic review. Key terms were utilized to guide searches in four databases. The two reviewers deduplicated articles and came to a consensus for the final sample using inclusion and exclusion criteria. MEDLINE/OVID, CINHAL, COCHRANE and WEB OF SCIENCE. There were 10 studies included. PCC was associated with better outcomes for persons with dementia (i.e. decreased restraint use, decreased length of stay, increased involvement with families and the patient, and increased nurse confidence and competence in caring for this population). Of the studies, none explicitly identified an association between nursing-sensitive outcomes, PCC and hospital organizational features in the acute care setting among persons with dementia. This review highlights a clinically significant gap in knowledge regarding associations between hospital organizational features, PCC and nursing sensitive outcomes. The impact of face-to-face dementia competency training as a standard practice among acute care facilities, the importance of leadership engagement, support and involvement to improve nurse confidence and competence in caring for persons with dementia needs to be explored. These findings support future research to understand the relationship between organization features and patient-centred care and how these collectively impact nursing-sensitive outcomes, specifically in persons with dementia in acute care settings.

Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned

As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.

Prevention and management of behavioural and psychological symptoms in patients with dementia in acute care: a best practice implementation project.

Behavioural and psychological symptoms of dementia are very common in acute care. Agitation and aggressive behaviours are the most common symptoms and are challenging to manage. Early detection and a nonpharmacological approach are recommended. To implement evidence-based recommendations for the prevention and management of aggression/agitation in patients with dementia in an acute geriatric care unit. The project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted with seven audit criteria based on evidence summaries. It was followed by the implementation of an action plan and a follow-up audit. Results showed moderate improvements in compliance with best practice recommendations. The second audit indicated an improvement up to 46% with the identification of factors/triggers that precipitate aggression/agitation and completion of a risk assessment. The highest improvement was the training of the nursing team (79%). Compliance with the involvement of patients and their families in the care planning improved slightly (14%). The lowest improvement was for the development and implementation of individualized care plans (10%). The project implementation achieved some positive changes. A formalized process for preventing aggression/agitation is in place. The interprofessional collaboration, the support given to the nursing team and the basket of nonpharmacological interventions were strengthened. The electronic documentation and a limited collaboration of the nursing team were challenging. As further strategies were implemented, further audit would be required to assess achievement in change and/or demonstration of improved care provided for this vulnerable population.

Hospital nurses' knowledge and confidence in caring for persons living with Alzheimer’s disease and other dementias

AbstractBackgroundPersons living with Alzheimer’s Disease and other dementias (PLWD) are twice as likely to be hospitalized compared to cognitively intact older adults and while hospitalized are significantly more likely to experience complications and increased length of stays. The purpose of this study is to determine if confidence in caring for PLWD is associated with knowledge of dementia in acute care nursing staff. We hypothesize that knowledge and confidence will be highly correlated. Additionally, we hypothesize that a higher knowledge of dementia will be associated with higher education and less elderspeak (i.e., infantilizing communication) use.MethodNursing staff (N=65) were recruited from one university hospital in the midwestern United States. A subset of nursing staff (n=32) were observed and audio‐recorded during care encounters with PLWD (n=16) and the nursing staff’s communication was coded for elderspeak using a reliable and evidence‐based coding scale. The nursing staff completed the 9‐item Confidence in Dementia (CODE) scale (9=not confident to 45=very confident) and 16‐item true or false Knowledge in Dementia (KIDE) scale (0=no items correct to 16=all items correct). The associations between nursing staff confidence, knowledge, and demographic characteristics were determined using Pearson’s correlation coefficient for continuous variables and ANOVA for categorical variables.ResultNursing staff were somewhat confident (mean=33.9, SD=4.9) in providing care to PLWD. More years working in healthcare was associated with higher confidence (r=.28, p=.03). Role, age, use of elderspeak, gender, education, and hospital unit were not associated with confidence. Nursing staff averaged 85% on the KIDE scale. More years working in healthcare was associated with lower knowledge (r=‐.26, p=.04) and staff nurses had higher knowledge compared to nursing assistants (p<.001). Age, use of elderspeak, gender, and hospital unit were not associated with knowledge. Confidence and knowledge were not associated (r=.02, p=.90).ConclusionConfidence in caring for a PLWD was not associated with knowledge of dementia itself. Acute care nursing staff—particularly experienced staff and nursing assistants—are in need of greater dementia education. Effective educational interventions for dementia care are warranted in order for education to enhance confidence in caring for PLWD.

“Getting to Know Them”: Person-Centered Care for Patients With Dementia in Acute Care

Older adults with dementia are reported to have twice as many hospital stays as their age-matched counterparts without dementia. Acute care hospitals are generally not equipped to provide best care for persons with dementia. The purpose of the current qualitative study was to gain an understanding of the needs and perspectives of nursing staff and patient care technicians regarding delivering person-centered care (PCC) to patients with dementia. Nine focus groups (N = 49) were conducted. Participants discussed the importance of "getting to know them" as the basis for their care. Several themes emerged that served to support or detract from providing PCC: (a) communication, (b) education, and (c) care environment. Findings from this study support the desire of nurses and patient care technicians to provide PCC, highlight challenges, and indicate needed system-level changes to education, communication, and the care environment to support best practices. [Journal of Gerontological Nursing, 47(5), 37-44.].

A Structured Physical Exercise Program Reduces Professional Caregiver's Burden Caused by Neuropsychiatric Symptoms in Acute Dementia Care: Randomized Controlled Trial Results.

Physical exercise is an effective treatment approach for neuropsychiatric symptoms (NPS), but it is unknown whether the reduction of NPS has an impact on professional caregiver's burden. A randomized controlled trial in acute dementia care with N = 70 patients, n = 35 per group, was conducted. The intervention group (IG) received an exercise program, the control group a social stimulation program. The RM-ANOVA showed a significant group x time interaction with time effects for the IG and decreased caregiver burden due to the exercise program at follow-up. Physical exercise programs may not only be beneficial for the patients but also for their professional caregivers.

Interprofessional Education and Collaborative Practice Model for Dementia in Acute Care

Interprofessional Education and Collaborative Practice Model for Dementia in Acute Care

Healthcare professionals’ perceptions of P.I.E.C.E.S. education in supporting care delivery for older adults with responsive behaviours of dementia in acute care

ABSTRACTIntroduction: In acute care settings persons with dementia often use responsive behaviours such as yelling and hitting as a meaningful mode of communication. Staff dementia care education programs such as P.I.E.C.E.S. may help to address these gaps in care. P.I.E.C.E.S. is a holistic clinical assessment framework that focuses on Physical, Intellectual, and Emotional health, Capabilities of an individual, and the living Environment of a person and the Social being.Aims: The aim of this interpretive descriptive study was to explore the perceptions of healthcare professionals of P.I.E.C.E.S. and recommendations to enhance its uptake.Methods: A total of 15 healthcare professionals from acute medical settings in a hospital in Ontario participated in face-to-face, semi-structured interviews. Experiential thematic and secondary data analyses were performed.Findings: P.I.E.C.E.S. had many positive perceived impacts such as promoting interdisciplinary collaboration. However, participants reported that it was challenging to sustain P.I.E.C.E.S. in practice which led to a tapering off of it approximately one year post-education. A barrier to applying P.I.E.C.E.S. was limited time.Conclusions: Findings indicate the need for educational reinforcements and sustainability strategies for dementia care programs in acute care settings. Organizations should implement regular interdisciplinary meetings to provide opportunities for staff to apply P.I.E.C.E.S.

Nurses' Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care.

Introduction: Approximately 56,000 individuals with dementia were admitted to Canadian hospitals in 2016, and 75% of them experience responsive behaviors. Responsive behaviors are words or actions used to express one's needs (e.g., wandering, yelling, hitting, and restlessness). Health-care professionals perceive these behaviors to be a challenging aspect in providing care for persons with dementia.Aims: This study explores the perceptions of nurses about (a) caring for older adults with dementia experiencing responsive behaviors in acute medical settings and (b) recommendations to improve dementia care.Methods: Thorne's interpretive description approach was used. In-person, semistructured interviews were conducted with 10 nurses and 5 allied health professionals from acute medical settings in an urban hospital in Ontario. Interviews were conducted with allied health professionals to understand their perspectives regarding care delivery for persons with responsive behaviors of dementia. Data were analyzed using Braun and Clarke's experiential thematic analysis.Findings: Themes related to caring for individuals with responsive behaviors included (a) delivering care is a complex experience, (b) using pharmacological strategies and low investment nonpharmacological strategies to support older adults with responsive behaviors, (c) acute medical settings conflicted with principles of dementia care due to a focus on acute care priorities and limited time, and (d) strong interprofessional collaboration and good continuity of care were facilitators for care.Conclusions: Findings provide guidance for improved support for nurses who provide care for individuals experiencing responsive behaviors in acute medical settings such as increasing staffing and providing educational reinforcements (e.g., annual review of dementia care education and in-services).

Prominent physical inactivity in acute dementia care: Psychopathology seems to be more important than the dose of sedative medication.

IntroductionTo objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care.Materials and MethodsIn this cross‐sectional study, we assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine‐equivalents and daily benzodiazepine medication is reported as diazepam‐equivalents. We assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen‐Mansfield Agitation Inventory.ResultsWe analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms.DiscussionThe results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients.

The role of participatory music making in supporting people with dementia in hospital environments.

Background Improving the quality of care for people with dementia in general hospitals is a key priority. Creative activities including music have been examined for their potential role in enhancing quality of life for people with dementia, although relatively few studies have evaluated their use in acute hospital settings. Methods A mixed methods study examined the effects of a ten week period of weekly music sessions on the wellbeing of patients with dementia and on the ward environment in an acute elderly care service in a UK hospital. Potential effects of the music project on the ward environment were examined by comparing descriptive quantitative ward level data for two equivalent time periods, one with music and one with no music. The impact of the activity on participants' wellbeing was assessed using observational data as well as semi-structured interviews and focus groups with patients, visitors, the musician and staff. Results Ward level data were available for 85 patients with a dementia diagnosis who had stayed on the wards during the study periods. Comparison between the two periods showed a number of differences between the music and the non-music time periods, including a reduction in prescription of antipsychotic drugs. However, many factors could have contributed to the differences in the ward environment. Observational data revealed nuanced responses to music and suggested that participants generally enjoyed the activity. The impacts of music making were mediated strongly by staff responses and hospital organisation. Conclusion Data from this limited pilot study suggest that music is a useful intervention for enhancing patient and staff experiences and improving care in acute dementia care environments. The suggestion that use of anti-psychotic drugs may be reduced when music is present warrants further research.

Care for older people with dementia in acute care: A call to action

Care for older people with dementia in acute care: A call to action

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT

BackgroundThe primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care.MethodsWithin a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents.ResultsEighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication.ConclusionsThis exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia.Trial registrationGerman Clinical Trial Register DRKS00006740. Registered 28 October 2014.

Integrated Care Pathways and Care Bundles for Dementia in Acute Care: Concept Versus Evidence.

Caring for people with dementia in acute settings is challenging and confounded by multiple comorbidities and difficulties transitioning between community and acute care. Recently, there has been an increase in the development and use of integrated care pathways (ICPs) and care bundles for defined illnesses and medical procedures, and these are now being promoted for use in dementia care in acute settings. We present a review of the literature on ICPs and/or care bundles for dementia care in the acute sector. This includes a literature overview including "gray literature" such as relevant websites, reports, and government publications. Taken together, there is clearly a growing interest in and clinical use of ICPs and care bundles for dementia. However, there is currently insufficient evidence to support the effectiveness of ICPs for dementia care in acute settings and limited evidence for care bundles for dementia in this setting.

Effects of Short-Term Exercise Interventions on Behavioral and Psychological Symptoms in Patients with Dementia: ASystematic Review.

Observational and interventional studies indicate adirect link between the patients' physical activity and the extent of behavioral and psychological symptoms of dementia (BPSD). At present, there are no evidence-based recommendations for physical exercise in the acute dementia care settings. Hence, this systematic review investigates the effects of short-term exercise trials on BPSD. Trials with alength up to three months investigating the effects of structured exercise interventions on BPSD in acute dementia care settings were included. Five trials, referring to atotal of N = 206 patients, met the inclusion criteria. The trial durations ranged from three up to twelve weeks. All trials conducted three sessions per week of 30 to 45 minutes. Three trials reported significant reductions of BPSD and differences in comparison to the pre-test and control groups. Out of the three trials investigating the effects of exercise interventions on depressive symptoms, one reported significant reduction and two reported no differences in pre-post analysis. Exercise represents apotentially worthwhile approach for the treatment of patients suffering from BPSD. Given the scarcity of available studies, more randomized controlled short-term exercise trials in acute dementia care settings are needed to define appropriate exercise recommendations for clinicians treating these patients.

Improving Management of Behavioral and Psychological Symptoms of Dementia in Acute Care: Evidence and Lessons Learned From Across the Care Spectrum.

As the prevalence of Alzheimer disease and related dementias increases, dementia-related behavioral symptoms present growing threats to care quality and safety of older adults across care settings. Behavioral and psychological symptoms of dementia (BPSD) such as agitation, aggression, and resistance to care occur in nearly all individuals over the course of their illness. In inpatient care settings, if not appropriately treated, BPSD can result in care complications, increased length of stay, dissatisfaction with care, and caregiver stress and injury. Although evidence-based, nonpharmacological approaches to treating BPSD exist, their implementation into acute care has been thwarted by limited nursing staff expertise in behavioral health, and a lack of consistent approaches to integrate behavioral health expertise into medically focused inpatient care settings. This article describes the core components of one evidence-based approach to integrating behavioral health expertise into dementia care. This approach, called STAR-VA, was implemented in Veterans' Health Administration community living centers (nursing homes). It has demonstrated effectiveness in reducing the severity and frequency of BPSD, while improving staff knowledge and skills in caring for people with dementia. The potential for adapting this approach in acute care settings is discussed, along with key lessons learned regarding opportunities for nursing leadership to ensure consistent implementation and sustainability.

'They rush you and push you too much … and you can't really get any good response off them': A qualitative examination of family involvement in care of people with dementia in acute care.

To explore the role and needs of the family carer across different acute care contexts and their level of involvement in the care of their relative with dementia in this setting. A pragmatic, exploratory-descriptive qualitative approach. A convenience sample of 30 family carers across three sites completed semi-structured interviews. Family carers wanted to be involved in the acute care of their family member with dementia. They acknowledged the importance of a central source of information, educated staff, guidelines on roles and processes, and positive communication, as well as respect from staff for the carer's knowledge of the older person and their needs. They also highlighted the need for medical staff to discuss with them the family member's treatment and care. There is a need for family-focused interventions to improve communication and involvement of family in the care of family members with dementia in the acute setting.

Acute hospital care: how much activity is attributable to caring for patients with dementia?

People with dementia are among the most frequent service users in the acute hospital. Despite this, the acute hospital is not organized in a manner that best addresses their needs. We examined acute dementia care over a 3-year period from 2010 to 2012 in a 600-bed university hospital, to clarify the service activity and costs attributable to acute dementia care. Nine hundred and twenty-nine patients with dementia were admitted during the study period, accounting for 1433/69 718 (2%) of all inpatient episodes, comprising 44 449/454 169 (10%) of total bed days. The average length of stay was 31.0 days in the dementia group and 14.1 days in those >65 years without dementia. The average hospital care cost was almost three times more (€13 832) per patient with dementia, compared with (€5404) non-dementia patients, accounting for 5% (almost €20 000 000) of the total hospital casemix budget for the period. Service activity attributable to dementia care in the acute hospital is considerable. Moreover, given the fact that a significant minority of cognitive impairment goes unrecognized after acute admissions, it is likely that this is under-representative of the full impact of dementia in acute care. Although the money currently being spent on acute dementia care is considerable, it is being used to provide a service that does not meet its user needs adequately. It is clear that acute hospitals need to provide a more 'dementia friendly' service for acutely unwell older persons.

Do nurses in acute care settings administer PRN analgesics equally to patients with dementia compared to patients without dementia?

Summary Aim The aim of this pilot study is to examine whether patients with a diagnosis of dementia are less likely to receive pro re nata (PRN) analgesics than patients of the same age without a diagnosis of dementia when they are admitted to an acute care facility with a bone fracture. Methods This pilot study used quantitative methodology and a correlational design to compare patients with and without a diagnosis of dementia, aged over 65 years and admitted to an acute care facility with a bone fracture. Retrospective data was collected from the medical records of 10 patients with a diagnosis of dementia and 10 patients without a diagnosis of dementia that fit the inclusion criteria. Analysis of variance was used to determine whether there was a relationship between age, gender, and a diagnosis of dementia and the amount of PRN enteral morphine equivalent a patient received. Results There were no statistically significant predictor variables found when examining the effect of age and gender on the amount of PRN opioid analgesics received by patients. At the 10% significance level, patients without a diagnosis of dementia received significantly more PRN analgesics than patients with a diagnosis of dementia in the first 3 days of admission. There was no significant relationship between opioid analgesia and a diagnosis of dementia after the 24h and 7 day periods. Conclusion The results from this pilot study indicate that patients without a diagnosis of dementia may be receiving more PRN opioid analgesics than patients with a diagnosis of dementia in acute care when admitted with a bone fracture. Further research is required to provide evidence on which generalisations can be made and to improve quality of life for people with dementia admitted to an acute care hospital.

Informant single screening questions for delirium and dementia in acute care--a cross-sectional test accuracy pilot study.

BackgroundCognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.MethodsPatients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).ResultsInformant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.ConclusionsThese findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.