A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis

Sinvani, Liron; Warner‐Cohen, Jessy; Strunk, Andrew; Halbert, Travis; Harisingani, Ruchika; Mulvany, Colm; Qiu, Michael; Kozikowski, Andrzej; Patel, Vidhi; Liberman, Tara; Carney, Maria; Pekmezaris, Renée; Wolf‐Klein, Gisele; Karlin-Zysman, Corey

doi:10.1111/jgs.15452

Cited by 24 publications

(26 citation statements)

References 46 publications

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“…These findings and conclusions are in line with other studies on hospital care that suggest that an increased staff ratio or the implementation of multiple components, which particularly address the needs of patients with dementia, leads to reduced use of physical restraints and psychotropic drug use and improves the quality of care 57 58. Furthermore, dementia-specific educational programmes, as implemented in the special care ward, have positive effects on nurses with regard to their interaction with patients with dementia.…”

Section: Discussionsupporting

confidence: 86%

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

et al. 2019

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ObjectivesTo identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients’ QoL.DesignA non-randomised, case–control study including two internal medicine wards from hospitals in Hamburg, Germany.Setting and participantsIn all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept.Outcome measuresOur main outcome was the QoL (range 0–100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL.ResultsQoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: −4.9), psychotropic drug use (−4.4) and agitation (−2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7).ConclusionsA special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.

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Section: Discussionsupporting

confidence: 86%

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

et al. 2019

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“…The studies exploring family caregivers' satisfaction with care in special geriatric units revealed both less dissatisfaction [47] and more satisfaction with care [40] compared to standard care wards. Additionally, evaluation of special geriatric unit models revealed lower in-hospital mortality, shorter stays, less need for constant or enhanced observations, reduced use of psychotropic medication and occurrence of delirium compared to standard wards [42,46]. Evaluation of the effectiveness of an acute hospital dementia unit adopting a person-centred care protocol moderating intrusive interventions revealed positive impacts on quality of life such as decreased agitation in people with dementia and confirmed cost-effectiveness [50].…”

Section: Interventionsmentioning

confidence: 83%

“…has distinguishable features and a view of the outdoors, and 2) staff's experience of the physical environment as a barrier for patient safety. Experiences and needs of patients with dementia related to the physical environment in acute hospital wards were described from the perspective of staff [25,29,[33][34][35][36] persons with dementia [28,34,46], family carers [34] and by observations [31,35]. The studies demonstrate the importance of an environment that enables independence for people with cognitive impairment by making it easier to navigate the surroundings.…”

Section: Categories Themesmentioning

confidence: 99%

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What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature

Røsvik¹,

Rokstad²

2020

BMC Health Serv Res

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Background: Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment. Conclusion: The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.

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“…• Environmental changes (Sinvani et al, 2018) Retrospective chart review. "Sitter" "Constant observation" "companions" "one-to-one patient care" "the "Special" role" • Untrained role "Communication"…”

Section: "Specialling"mentioning

confidence: 99%

What are we asking for when requesting “Specialling” for the confused hospitalised older person? A concept analysis

Coyle

Wilson

Lapkin

et al. 2019

Int J Older People Nursing

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Background and/or rationale: "Specialling" is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness.To facilitate further investigation, a concept analysis of "specialling" was undertaken.Aims: The aim of this paper was to report on a concept analysis on the practice of "specialling" pertaining to older people who have cognitive impairment when in hospital. Methods:This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of "specialling." Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding. Findings:A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the "Special" role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; andOrganisational risk. The consequences of "specialling" were diverse with 6 themes: the "Special" role; the Older persons experience; Costly; "Special" use and nursing beliefs; Safety outcomes; and Opportunities. Discussion:The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person-centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study. Implications for practice:Nurses have an opportunity to lead care improvements by ensuring person-centred approaches in the care of older people with cognitive impairment. K E Y W O R D Sacute care, aged care, cognitive impairment, concept analysis, delirium, dementia, hospital setting, older people, specialling • This study clarifies the concept and provides a contemporary definition of "specialling" among older people in acute care settings.• The evolutionary concept analysis identified five attributes, two antecedents and six consequences of "specialling" when used to care for the older person in hospital settings.• Nurses have an opportunity to lead care improvements by ensuring person-centred approaches in the care of older people with cognitive impairment.What are the implications of this new knowledge for nursing care with older people?• The contemporary definition of "specialling" developed provides reflective opportunity for clinicians and researchers.• "Specialling" should be implemented in a meaningful way that incorporates engagement between the multidisciplinary team, the older person and their families. How could the findings...

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A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis

Abstract: A multicomponent intervention of geographic cohorting, multidisciplinary approach, PES, and staff education may offer a new paradigm in the management of hospitalized older adults with cognitive impairment.

Cited by 24 publications

References 46 publications

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature

What are we asking for when requesting “Specialling” for the confused hospitalised older person? A concept analysis

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