Dementia Ward Research Articles

An evaluation of activities and intervention approaches in an acute dementia setting

Background:Recommended interventions for dementia prioritises person-centred care and non-pharmacological approaches. The evidence-base for various therapies such as Cognitive Stimulation Therapy (CST), music therapy and sensory based interventions has been growing in recent years; however, there is limited guidance surrounding best practice for working with advanced dementia in acute settings, and research regarding the evaluation of ward interventions is scarce.Method:An audit checklist was compiled from the current recommendations and evidence base. Observations of structured activity sessions were conducted across two acute dementia wards to identify how well these aligned with evidence-based recommendations.Results:Our results suggest that activity sessions on the wards align to the evidence base. Specifically, the wards offer high quality interventions integrating CST approaches. It was revealed that the capturing of these interventions was limited within the clinical notes systems, and an action plan to facilitate efficient capturing was identified and initiated.Conclusion:The study found that it is possible to offer evidence-based activity sessions in an acute setting, for patients with typically advanced dementia presentations. Staff feedback led to the production of a poster to help staff identify the interventions they implicitly use as part of their role, aiming to encourage staff to be proud of their work on the ward and be more aware of evidence-practice links.

Using PARO, a robotic seal, to support people living with dementia: ‘what works’ in inpatient dementia care settings?

Abstract Introduction: The robotic seal PARO has received increased attention as a new technology to support people living with dementia in terms of emotional and physiological outcomes. However, little research has been conducted to improve understanding of how and why PARO may work within inpatient dementia care. We investigate for whom PARO works best in this setting, and why PARO may work. Methods: Informed by principles from realist methodology, qualitative interviews were conducted with healthcare professionals, participants with dementia and their relatives to explore experiences related to the delivery and receipt of an intervention using PARO in an inpatient dementia ward in the United Kingdom (UK). Observations of PARO intervention sessions were conducted to gain further insight into provision and implementation of sessions using PARO in ‘real time’. Data were analysed using thematic analysis, and using the process of configuration mapping, we constructed a visualisation of our findings framed within the Intervention-Context-Actor-Mechanisms-Outcomes (ICAMO) model. Results: The visualisation of our findings framed within the ICAMO model suggests that PARO may result in positive outcomes within inpatient dementia care due to a range of potential mechanisms, including enhancement of social interactions, developing a sense of attachment, evoking emotive memories, physical interaction, and perceiving the robotic animal as a live being. For these mechanisms to be activated, the sessions should be structured but participant-led, and be delivered as needed in a one-to-one setting by a skilled facilitator. Conclusion: Using PARO in an inpatient dementia care context appeared promising and well-received in this small observational study. This study explicitly considers the context and mechanisms of using PARO within inpatient dementia care settings, presenting findings in a structured visualisation framed within the ICAMO model and offering a theoretical basis for future intervention research.

Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period.

The COVID-19 pandemic led to behavioral exacerbations in people with dementia. Increased hospitalizations and lack of bed availability in specialized dementia wards at a tertiary psychiatric hospital in Singapore resulted in lodging people with dementia in the High Dependency Psychiatric Unit (HDPCU). Customizations to create a dementia-friendly environment at the HDPCU included: (1) environmental modifications to facilitate orientation and engender familiarity; (2) person-centered care to promote attachment, inclusion, identity, occupation, and comfort; (3) risk management for delirium; and (4) training core competencies. Such practical solutions can also be implemented elsewhere to help overcome resource constraints and repurpose services to accommodate increasing populations of people living with dementia.

Spiritual care in the dementia ward during a pandemic.

The Covid-19 pandemic and the repeated lockdowns have caused substantial spiritual and existential suffering, not the least for persons with dementia who may have had more difficulties than others in grasping the reality of what was going on. Therefore, it is important to address spirituality within this sector of the population when considering global health and ethics and technology in a pandemic outbreak. This contribution starts firstly with a definition of spirituality and spiritual care. Secondly, based on the works of Elizabeth MacKinlay and Laura Dewitte, the article demonstrates how spirituality can be nurtured in the dementia ward through "spiritual reminiscence." Finally, I briefly reflect on how spiritual care in the dementia ward was affected by the Covid-19 pandemic.

Characteristics, outcomes, facilitators and barriers for psychosocial interventions on inpatient mental health dementia wards: a systematic review

BackgroundThe National Institute for Health and Care Excellence guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress behaviours, such as agitation and depression. However, little is known about the characteristics and outcomes of psychosocial interventions or the facilitators and barriers to implementation on inpatient mental health dementia wards which provide care for people with dementia who are often experiencing high levels of distress.MethodsA systematic search was conducted on MEDLINE, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, and Scopus in May 2023, following PRISMA guidelines. Reference and citation searches were conducted on included articles. Peer-reviewed literature of any study design, relating to psychosocial interventions in inpatient mental health dementia wards, was included. One author reviewed all articles, with a third of results reviewed independently by a second author. Data were extracted to a bespoke form and synthesised using a narrative review. The quality of included studies was appraised using the Mixed Methods Appraisal Tool.ResultsSixteen studies were included in the synthesis, which together included a total of 538 people with dementia. Study methods and quality varied. Psychosocial interventions delivered on wards included music therapy (five studies), multisensory interventions (four studies), multicomponent interventions (two studies), technology-based interventions (two studies), massage interventions (two studies) and physical exercise (one study). Reduction in distress and improvement in wellbeing was demonstrated inconsistently across studies. Delivering interventions in a caring and individualised way responding to patient need facilitated implementation. Lack of staff time and understanding of interventions, as well as high levels of staff turnover, were barriers to implementation.ConclusionThis review highlights a striking lack of research and therefore evidence base for the use of psychosocial interventions to reduce distress in this vulnerable population, despite current healthcare guidelines. More research is needed to understand which psychosocial interventions can reduce distress and improve wellbeing on inpatient mental health dementia wards, and how interventions should be delivered, to establish clinical and cost effectiveness and minimise staff burden.

Legal Representation of Patients with Dementia in Long Term Care Settings

Introduction: Dementia is a neurodegenerative disease which affects cognitive, physical, and behavioural abilities. To date there is no effective disease-modifying treatment, so the course of disease is progressive [1]. Worsening cognition in advanced stages can impair the person’s mental capacity to make decisions. Consequently, advanced care planning (ACP) is an important aspect in dementia management [2]. Guardianship is an integral part of ACP where the patient legally appoints a trusted person to make best interest decisions for them should they lose capacity. As a result, this study aims to assess the legal representation of patients suffering from dementia. Method: Patients residing in all the nine dementia wards at Saint Vincent De Paul Residence (SVPR), were recruited (203 patients). A diagnosis of dementia is a requirement for admission to these wards. A data collection sheet was designed and included data on the patient’s demographics, MMSE scores and guardianship statuses. Data was collected retrospectively from the patient’s medical records and their caring medical team where documentation was lacking. The data collection period included September to October 2022. Results: Only 7 patients had a guardianship present (3%). The patients’ children (57.1%) were more likely to apply for guardianship, followed by the patients’ spouses (28.6%). The guardianship status was clearly documented in the doctors’ notes and next of kin (NOK) paper, together with the name and contact details of the guardians. 196 patients (97%) did not have guardianship. 5 of these had a power of attorney (POA) but the type was not specified. 190 patients had a relative or friend listed as the next of kin (NOK) and a patient had no legal guardian or NOK. Conclusion: Most patients with Dementia did not have formal legal representation like guardianship or valid POAs. However, the majority of NOK documented were in line with the legal definition of the responsible carer according to the MHA

Alterations of neuropsychiatric symptoms in dementia patients during hospitalization in a dementia ward.

Alterations of neuropsychiatric symptoms in dementia patients during hospitalization in a dementia ward.

Comparison of Management (Non-Pharmalogical Approaches and Rapid Tranquilisation) of Older Adults (≫65 Years) With Dementia Between the Dementia Ward, Acute Medical Unit and the Geriatric Ward in a Rural Health Board

AimsTo investigate if current practices by nursing and medical staff in the dementia ward (New Craigs Psychiatric Hospital), acute medical unit and geriatric ward (Raigmore General Hospital) followed the local protocol for managing distress of non-pharmalogical approach and rapid tranquilisation (RT) in older adults (aged >65years). We believe the split between the general and psychiatric hospitals and the different time pressures experienced in these 3 wards will influence the management and RT of their older adult patients.MethodsData were collected from 17/09/2022 to 8/10/2022 from case notes and drug charts of older adult patients that received rapid tranquilisation from 3 wards: 1.Ruthven Ward, New Craigs Psychiatric Hospital2.Acute Medical Unit (AMU), Raigmore Hospital3.Ward 2C (Geriatrics), Raigmore HospitalFocus groups and informal discussions were made with the ward nurses and junior doctors to understand their point of view on managing distressing behaviours in patients with dementia using de-escalation techniques.A table was collated using Microsoft Excel. The parameters used were: 1.Patient Diagnosis and Legal status2.Administration•Date and time started•If de-escalation techniques were used•If discussed with a senior doctor•1st and/or 2nd line of drugs administered (route, drug and dosage)•If Haloperidol given and if ECG was doneResultsData collection showed the following: 1.Ruthven Ward- all 32 patients did not receive RT.2.AMU- only 1 out of 280 patients received 4 subsequent RT in 5 hours including 3x haloperidol (total 3mg) and 2mg of Midazolam despite an ECG showing prolonged QT interval. The latter prescribed after consultation with a senior doctor.3.Geriatric Ward – all 10 patients did not receive RT.ConclusionFocus groups and informal discussions with staff nurses from all three wards concluded that in spite of the stressful environment posed by issues of understaffing and high patient load, de-escalation techniques (recognition of early signs of agitation, distraction and calming techniques, recognising the importance of personal space) were prioritised before moving on to RT as per local protocol. Restraining was often used if patient was at risk to self or others by staff trained in violence and aggression management.Informal discussions with junior doctors rotating in and out of AMU showed limited awareness of the RT protocol. In general, it was evident that RT was a last resort when psychological and behavioural approaches failed but that further education was required to administer RT safely.

Social networks of neighbourhood inhabitants, residents of a care facility, and the nursing staff: a case study in two LTF facilities in the Netherlands

AbstractBackgroundSocial resources have the potential to relieve the pressure on long‐term care facilities due to population ageing and staff shortages. This is because social networks can constitute the link between residents, staff members of LTC facilities and members of the local community. In this paper we describe these social networks and the relationships of which they consist in two LTC facilities that provide dementia care in the Netherlands, thereby illustrating the social capital of both facilities.MethodsStaff members of the dementia ward in two LTC facilities, family members of residents and inhabitants of the neighbourhoods surrounding the LTC facilities were asked to complete questionnaires.ResultsThere are direct and indirect relationships between nursing staff, family members of residents and inhabitants of the neighbourhood. Staff know residents both directly, and indirectly through connections with other persons in the community. There is regular contact between staff members and family members of residents during visits of family members; one third of nursing staff also talk to family members outside the LTC facility. Furthermore, staff members often live close to the facility and are therefore connected to inhabitants of the neighbourhood. About half of the neighbourhood inhabitants visited the LTC facility during the past 12 months for various reasons. More than half of the neighbourhood inhabitants know persons that work in the LTC facility, one in five knows a staff member working on the dementia ward. In total, 8% of the neighbourhood inhabitants in our study worked as a volunteer in the LTC facilities.ConclusionThe network of the LTC facilities’ staff, residents with dementia, and local community consists of many direct and indirect relationships. Although it is difficult for residents with dementia to uphold their social networks, there are numerous ties that demonstrate the pre‐existing social relationships of persons with dementia in the community that can be employed to provide person‐centred care. The embeddedness of LTC facilities can also be considered as a resource in finding and retaining personnel and volunteers, as most of the staff live in the neighbourhood and volunteers are often in close proximity.

Lateral temporal atrophy is a better visual scale to predict MMSE score than hippocampal atrophy in Alzheimer’s disease: A retrospective cross‐sectional study

AbstractBackgroundMini‐Mental State Exam (MMSE) is helpful in the cognitive evaluation and staging of Alzheimer patients (AD), but its score could be affected by acute medical conditions, depression, or anxiety. Conversely, head magnetic resonance imaging (MRI) is an independent diagnostic tool to evaluate specific cerebral pathology in AD patients. Many studies have investigated the correlation between head MRI visual scales such as hippocampal atrophy and baseline MMSE to aid in the diagnosis of AD. However, there has not been a study that evaluates the correlation between a comprehensive head MRI visual scale with baseline MMSE in AD patients.MethodWe retrospectively collected records of outpatients diagnosed as probable AD according to DSM V criteria in two dementia wards. Patients with age of onset before 65 years old were considered early‐onset AD patients. The comprehensive visual rating scale (CVRS) was used to semiquantitative structural lesions, including hippocampal, cortical, subcortical atrophy, and small vessel disease. The relationship between MRI lesions and baseline MMSE was evaluated using Bayesian model averaging (BMA) to control confounders. Data analysis was done using R‐4.0.3.ResultWe collected 65 AD patients with 21 (32.31%) early‐onset AD. Lateral temporal atrophy, level of education, and late age‐onset were the strongest independent predictors of baseline MMSE, while other structural lesions were not significant in the BMA model. Furthermore, hippocampal atrophy was only correlated with delayed recall, while temporal atrophy was correlated with orientations, attentions, language, and visual‐spatial.ConclusionOur study suggests that the lateral temporal atrophy correlates more with the baseline MMSE score in patients with AD than the hippocampal atrophy.

Talking about Meaning and Loss with Relatives of Persons with Dementia: An Ethnographic Study in a Nursing Home

Advance care planning (ACP) can help prepare for future losses and decisions to be taken. However, relatives of persons with dementia may wait for healthcare professionals to initiate ACP conversations which may not adequately address their individual information needs. To evaluate inducing and enhancing conversations about meaning and loss, we conducted an ethnographic study on nurse-led ACP conversations using a question prompt list (QPL) on six dementia wards of a nursing home in the Netherlands from January to September 2021. Staff received training in using the QPL, with information and sample questions to inspire relatives to ask their questions, in particular on meaning and loss. Thematic analysis was applied to transcribed interviews and memos of observations. Nursing staff in particular was concerned about having to be available to answer questions continuously. Relatives used the study as an opportunity to get in touch with professionals, and they saw the QPL as an acknowledgement of their needs. There was a mismatch in that staff wished to discuss care goals and complete a care plan, but the relatives wanted to (first) address practical matters. A QPL can be helpful to conversations about meaning and loss, but nursing staff need dedicated time and substantial training. Joint agenda setting before the conversation may help resolve a mismatch in the preferred topics and timing of conversations.

Resilience – understanding staff needs

Aims:The project aimed to explore how the system (e.g. the work environment and role) affects staff resilience and how the system could support staff resilience.Background:Understanding factors impacting staff resilience and how staff can be supported is seen as important for improving staff wellbeing, increasing job satisfaction, staff retention and recruitment.Methods:Fifteen female participants working as staff members on a dementia ward were recruited to complete a qualitative questionnaire about their resilience. All participants were of working age. Responses were transcribed and analysed using thematic analysis.Results: Seven themes were identified from their responses as affecting resilience; staffing issues, staff stress, lack of support, not being listened to, not being valued, communication and feeling at risk. Staff also provided ideas for positive change and support that has previously been helpful which formed two additional themes. Recommendations and conclusions: Staff resilience was affected by different aspects of the system. Feedback suggested support that could be put in place to improve resilience such as drop-in sessions, debrief sessions and improved communication.

Pre-launch of the updatedGuide to Psychosocial Interventions in Early Stages of Dementia

This paper describes the development of an emotional ‘check-in’ group, conducted on a male dementia ward at an older adult mental health hospital, in Salford (Greater Manchester). The authors planned and conducted four sessions initially, with an aim to evaluate and adjust sessions dependent on engagement levels and responses from service users (SUs). For context, SUs admitted to the ward were males with diagnosis of dementia, who presented with complex behaviours that challenge. The ward environment included a high level of acute distress and frequent incidents that involve risk. This article outlines the structure and content of the first three sessions, explores the potential impact of the sessions and reflects on the importance of providing individuals with severe levels of cognitive impairment an opportunity to discuss emotions.

Piloting an emotional check-in group on a male dementia ward

This paper describes the development of an emotional ‘check-in’ group, conducted on a male dementia ward at an older adult mental health hospital, in Salford (Greater Manchester). The authors planned and conducted four sessions initially, with an aim to evaluate and adjust sessions dependent on engagement levels and responses from service users (SUs). For context, SUs admitted to the ward were males with diagnosis of dementia, who presented with complex behaviours that challenge. The ward environment included a high level of acute distress and frequent incidents that involve risk. This article outlines the structure and content of the first three sessions, explores the potential impact of the sessions and reflects on the importance of providing individuals with severe levels of cognitive impairment an opportunity to discuss emotions.

The prevalence of delirium in Belgian nursing homes: a cross-sectional evaluation

BackgroundDelirium is a common geriatric syndrome, but only few studies have been done in nursing home residents. Therefore, the aim of this study was to investigate (point) prevalence of and risk factors for delirium in nursing homes in Belgium.MethodsA multisite, cross-sectional study was conducted in six nursing homes in Belgium.Residents of six nursing homes were screened for delirium. Exclusion criteria were coma,‘end-of-life’ status and residing in a dementia ward. Delirium was assessed using the Delirium Observation Screening Scale.Results338 of the 448 eligible residents were included in this study. Of the 338 residents who were evaluated, 14.2 % (95 %CI:3.94–4.81) screened positive for delirium with the Delirium Observation Screening Scale. The mean age was 84.7 years and 67.5 % were female. Taking antipsychotics (p = 0.009), having dementia (p = 0.005), pneumonia (p = 0.047) or Parkinson’s disease (p = 0.03) were more present in residents with delirium. The residents were more frequently physically restrained (p = 0.001), participated less in activities (p = 0.04), had had more often a fall incident (p = 0.007), had lower levels of cognition (p < 0.001; MoCA ≥ 26, p = 0.04; MoCA ≥ 25, p = 0.008) and a higher “Activities of Daily Living” score (p = 0.001). In multivariable binary logistic regression analysis, a fall incident (2.76; 95 %CI: 1.24–6.14) and cognitive impairment (OR: 0.69; 95 %CI: 0.63–0.77) were significantly associated with delirium.ConclusionsDelirium is an important clinical problem affecting almost 15 % of the nursing home residents at a given moment. Screening of nursing home residents for risk factors and presence of delirium is important to prevent delirium if possible and to treat underlying causes when present.

Embodied meaning-making in the experiences and behaviours of persons with dementia.

The aim of the study was to explore and articulate how meaning-making appears and how meaningfulness is experienced in persons with severe dementia. Although there is little knowledge about meaning-making and experience of meaningfulness for this group, this article assumes that persons with dementia are as much in need of meaningfulness in life as any others, and hence, that they are involved in the process of meaning-making. The study was conducted using a qualitative method with exploratory design. Ten patients with severe dementia at a specialized dementia ward at an old age psychiatric department in hospital were observed through participant observation performed over four months. The field-notes from the observation contained narratives carrying with them a dimension of meaning played out in an everyday setting and thus named Meaning-making dramas. The narratives were analyzed looking for expressions where experiences of meaning-making and meaningfulness could be identified. The narratives demonstrate that persons with severe dementia are involved in processes of meaning-making. The narratives include expressions of meaning-making, and of interactions that include apparent crises of meaning, but also transitions into what may be interpreted as meaningfulness based on experiences of significance, orientation and belonging. The role of the body and the senses has proved significant in these processes. The findings also suggest that experiences of meaning contribute to experience of personhood. The relevance to clinical practice indicates that working from a person-centred approach in dementia care also includes paying attention to the dimension of meaning. This dimension is important both for the person living with dementia and for the people caring for them. Acknowledging meaning as a central human concern, it is crucial to seek understanding and knowledge about the significance of meaning in vulnerable groups such as persons with dementia.

Bowel monitoring in psychiatry of old age: a quality improvement project

AimsThis project aims to ensure all patients in the dementia ward 1 in Kingsway Care Centre, Dundee have daily bowel monitoring and achieve a normal bowel habit. The hypothesis is that patients are inadequately screened and substantial undiagnosed constipation exists.BackgroundConstipation has a prevalence of 16-50% among individuals over 65 years old in the community. Psychiatric illnesses are known risk factors with older psychiatric patients 3-6 times more likely to be constipated. Untreated constipation may progress to serious complications such as bowel obstruction and bowel perforation. Delirium, often mislabelled as worsening psychiatric symptoms, also may occur leading to additional psychotropic medications being prescribed, further worsening the constipation.MethodAll patients in Ward 1, Kingsway Care Centre Dundee over 4 months were included, amounting to 25 patients. Data were gathered from stool charts weekly. Quality improvement framework was followed with two plan-do-study-act (PDSA) cycles completed. Normal bowel function was assessed against ROME IV constipation criteria and less than 75% of Bristol stool type 6 or 7 due to the risk of overflow diarrhoea and laxative overuse. In the first PDSA cycle, stool charts were modified to account for patients independently mobilising to the bathroom and daily documentation even if bowel movements were uncertain. The second PDSA cycle introduced a sticker on charts folder to “ask the patient” along with a staff education leaflet on the complications of constipation. Data were anonymised and analysed with run charts using Microsoft Excel.ResultAt baselines, 50% of patients had a stool chart. This increased to 90% in cycle 1, 100% in cycle 2. 28% of patients had any stools documented at baselines. This increased to 31% in cycle 1, 59% in cycle 2. At baselines, 0% of patients had a normal bowel habit. This maintained at 0% in cycle 1 but increased to 13% in cycle 2. No serious complications were found in patients assisted with toileting. However, 34% of independently mobile patients developed serious complications.ConclusionPoor documentation existed in all patients, particularly those independently mobile. Independently mobile patients were particularly at risk of serious complications of constipation compared to assisted patients. Introduction of new stool charts in the first PDSA cycle resulted in increased documentation but limited benefit for identification of constipation. The second PDSA cycle, targeting staff education and compliance, showed an increase in identification of constipation indicating limited staff knowledge as a key barrier to improvement in patients’ bowel habit.

Neuroimaging in an older adult inpatient psychiatric unit

AimsThis audit aimed to analyse the use of neuroimaging and its effect on treatment in an older adult inpatient psychiatry unit over the period of one year.BackgroundBrain imaging can be used as a diagnostic tool in psychiatry. According to NICE guidelines, structural imaging, such as magnetic resonance imaging (MRI) or computed topography (CT), can be used in the workup for dementia diagnosis in order to exclude non-dementia pathology and identify dementia subtype. This is important in the geriatric population where evidence of small vessel disease has an impact on treatment options and management of polypharmacy.MethodA list of patients from the past year (January to December 2019) was accessed. Patient records were then analysed to see if neuroimaging had been accessed during their admission at The Meadows Hospital, Surrey and Borders Partnership. This included imaging from prior to admission. Analysis was divided into type of imaging, comments and impact on diagnosis.ResultOverall numbers for the audit were small. A total of 74 patients were admitted onto the unit, of which 3 were readmissions. There was missing information for 8 patients, giving a total of 63 patients. CT scans were accessed for 35 patients (56% of total); 3 of these were done during the admission. MRI scans were completed for 21 patients (33%), with one requested during admission. A total of 9 patients (14%) had both CT and MRI scans. Neuroimaging results led to a change in diagnosis for 6 patients (10%). In all cases this reflected the finding of small vessel disease and a change of diagnosis to either vascular dementia or mixed dementia.Diagnoses were also analysed. The Meadows Hospital has 2 dementia wards (male and female) and 1 functional ward (for females). A total of 36 patients (57%) were diagnosed with dementia, of which the biggest groups were: Alzheimer's dementia (13 patients, 36%) and Vascular dementia (11 patients, 31%).ConclusionThe majority of the patients were admitted with established diagnoses and so only a small number had changes made following review of imaging. Good imaging results and reports help to differentiate types of dementia. Although neuroimaging is not gold standard in diagnosing dementia syndromes, it is now an important aspect in the diagnostic pathway. Getting the diagnosis correct will help with treating individuals appropriately and avoid unnecessary prescribing.

An audit of the use of psychotropic medications over the course of admission to a specialist dementia ward

AimsThe aim of this audit project was to establish the practices in prescribing and de-prescribing of psychotropic medications for patients on a specialist dementia ward.BackgroundThere is a great deal of evidence demonstration high rates of polypharmacy, defined as ≥5 drugs, in older adults in general and in those with dementia more specifically. NICE guidelines recommend a structured assessment of a patient with dementia to exclude other potential causes, e.g. pain or delirium. Psychosocial interventions are recommended as first line. Antipsychotics should only be offered second line who present a risk to themselves or others. These should only be used for the shortest time possible and reassessed at least every 6 weeks.MethodData were collected for patients (n = 20) discharged from a specialist dementia ward between September 2018 and March 2019. The unit has 14 beds caring for patients with predominantly severe behavioural and psychological symptoms associated with dementia (BPSD). The team is comprised of doctors, nurses, a clinical psychologist, occupational therapists, physiotherapists and pharmacists who meet twice a week to review patients. Data were coded by drug class and counts of medication on admission, at the midpoint and at discharge were conducted. Antipsychotic and benzodiazepine dosages were converted into haloperidol and diazepam equivalence.ResultOf the 20 patients, 70% were male and 30% female. 95% of the patient (n = 19) were admitted under the Mental Health Act (1983). 20% were managed on 1 to 1 observations and 80% were on 15 min observations. In general, the results show little change in the overall rate of psychotropic prescribing. The mean number of psychotropic medications prescribed per patient on admission was 2.30, at the mid-point of admission it was 2.30 and at discharge it was 2.05. Mean benzodiazepine dosage in diazepam equivalence reduced between admission and discharge from 3.20 mg to 2.10 mg. Mean haloperidol equivalent dosages increased at the midpoint of admission from 1.11 mg to 2.27 mg before reducing to 0.78 mg at discharge.ConclusionThe results demonstrate minimal change in the overall average number and composition of drugs prescribed. There are differences in the use of regular antipsychotics and benzodiazepines between admission and discharge which are consistent with NICE guidelines. Patients had a structured assessment with regular medicines reconciliation supervised by the team pharmacist. Therefore, the ward environment did allow for detailed discussions about de-prescribing which may not be the case elsewhere.

What happens to people admitted to a specialist dementia unit in the west of Scotland?

AimsRecent local research examined mortality rates following admission to a dementia ward. We wanted to expand on this work and include other important health outcomes for patients admitted to our specialist in-patient dementia unit in the west of Scotland. This would provide a comprehensive overview of our in-patient population, aid service review and improve care. We hypothesised that patients admitted would be physically frail, have a significant mortality rate and would likely require long-term care post discharge.MethodThe clinical notes for each admission to the unit for one year were examined (total 62). We extracted data from a number of different areas such as demographics, mortality rates, discharge destination, readmission rates and prescribed medications.Result60% had an Alzheimer's/mixed dementia diagnosis. Average length of stay was 64 days. 62% were discharged to a care home (50% of this total had lived at home prior to admission), 18% to complex care and 20% to the community. 66% were prescribed an antipsychotic and the average number of medications was 8.4. 35% had a readmission under general medicine within a year of discharge. 19% died whilst an inpatient and a further 30% had died one year post-discharge (total one-year mortality of 44%).ConclusionPeople admitted to our dementia unit are physically frail, with only 20% returning to live in the community, 35% being readmitted to a general medical ward within a year of discharge and 44% dying during the admission or within a year of discharge. We need to bear these results in mind when considering if hospital admission is appropriate and ultimately further develop our skills in palliative and end of life care in order to provide those people admitted to our dementia unit (and those who remain at home) with the highest standard of care.