A systematic review of specialist inpatient dementia care services versus standard inpatient dementia care in acute hospitals

Abstract

Background Specialist inpatient dementia units (SIDU) have been developed to address adverse outcomes often experienced by people living with dementia admitted to acute hospitals. However, the evidence base of their effectiveness remains limited. Aim To review the current literature to establish the comparative effectiveness of acute hospital SIDU vs. standard ward care (SWC). Methods We did an online search of 12 biomedical databases from inception to 31st October 2017. Studies of inpatients with any form of dementia in acute hospitals, published in English language peer-reviewed journals, using experimental, observational or qualitative study designs, comparing SIDU with SWC and which measured any qualitative or quantitative outcome of the patient or carer experience were included in the search criteria. We used a standardised data extraction and appraisal form. Results Three of 46 full-text studies evaluated were suitable for analysis. Due to study heterogeneity, pooled odds ratios were only possible for mortality [OR 1.06 (CI 1.0–1.4)]. Otherwise, a narrative synthesis was performed. Although quantitative measures of length of stay, mortality and behavioural and psychiatric symptoms of dementia are not significantly lower, SIDU are associated with greater patient and carer satisfaction, reduced readmission rates, more accurate and comprehensive assessment processes, documentation of resuscitation decisions, and increased rates of discharge to the patient’s own home. Conclusions Although SIDU may be associated with improved care outcomes, the current evidence of their effectiveness is markedly limited. Further research and service evaluation of SIDU as a method for providing high-quality dementia care in acute NHS Trusts is needed. PROSPERO: CRD42017078364.

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

“…One was a cluster-randomised controlled trial [29], one used a repeated measures design [30] and three were controlled clinical trials [31][32][33]. Five of the studies were systematic reviews [14,15,[34][35][36]. The systematic reviews were published in 2015 [35] (n = 1), 2017 [34, 36] (n = 2) and 2019 [14,15] (n = 2).…”

“…Five of the studies were systematic reviews [14,15,[34][35][36]. The systematic reviews were published in 2015 [35] (n = 1), 2017 [34, 36] (n = 2) and 2019 [14,15] (n = 2). The interventional studies were published between 2011 and 2019, and only three studies were published before 2015 [20,27,29].…”

“…Of the interventional studies, five studies were conducted in Australia [22,23,28,32,33], four in the United States [20,24,29,30], two in the United Kingdom [21,26] and one each in Canada [31], Germany [27] and Switzerland [25]. All five systematic reviews were carried out in the UK [14,15,[34][35][36]. The included interventional studies presented a range of interventions for people with dementia in the acute hospital setting, including educational interventions for healthcare staff [21, 24, 26, 28, 31] (n = 5) or for volunteers working with people with dementia in hospital [27] (n = 1).…”

“…Further studies investigated a volunteer programme [33] (n = 1), a delirium management programme for people with cognitive impairment [25] (n = 1) and a special nonpharmacological intervention [20] (n = 1). The systematic reviews were on educational interventions [14,34] (n = 2), special care units for people with dementia [15] (n = 1), inpatient rehabilitation intervention for people with dementia after hip fracture on surgical units [35] (n = 1) and music therapy [36] (n = 1). Table 1 provides information about the characteristics of the included studies.…”

“…There are systematic reviews focusing on specific interventions for persons with dementia in the acute hospital setting, e.g. on educational and training interventions [14] or on special care units for patients with dementia [15]…”