Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Ahern, Susan; Cronin, Jodi; Woods, Noel; Brady, Noeleen M.; O’Regan, N; Trawley, Steven; Timmons, Suzanne

doi:10.1002/gps.5001

Cited by 7 publications

(8 citation statements)

References 39 publications

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“…In a study comparing patients discharged from psychiatric hospitals in Turkey with similar patients in Ireland, the presence of delirium or dementia was not associated with LOS, but the proportion of such patients in the sample was low: 13.6 per cent in Turkey and 25.5 per cent in Ireland; the only factor significantly associated with LOS was living alone (Carpar et al, 2018). In the last mixed-results study, a trend towards longer stay was seen for dementia patients, which was only significant in the subgroup who lived with a family member (11.61 vs. 7.55 days, p = 0.002) (Ahern et al, 2019). Authors also found that people with dementia admitted for a surgical procedure had a shorter stay than people without dementia (2.4 vs. 5.87 days, p = 0.001).…”

Section: Association Between Cognitive Impairment and Los Or Ddmentioning

confidence: 86%

“…It is of note that LOS or DD are also influenced by other factors inherent in the patient, for example, the causes of hospitalization and co-morbidities (Fick, Steis, Waller, & Inouye, 2013). Such factors, including admission diagnoses, could therefore be confounding the association between CI and LOS or DD (Ahern et al, 2019) by leading to a specific health care trajectory. Conversely, the self-management of some health issues may require greater cognitive function and could play a role in delayed discharge in less-severely impaired patients who desire to return home but may need additional services not readily available (Costa & Hirdes, 2010;Costa et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

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Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

et al. 2021

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Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

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Section: Association Between Cognitive Impairment and Los Or Ddmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

et al. 2021

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“…The DASS-21 is a self-report questionnaire assessing levels of caregiver stress, anxiety and depression over the previous seven [7] day period. The results provide an indication of the individual's perception of their experience of depression, anxiety and stress.…”

Section: Methodsmentioning

confidence: 99%

“…A further 9.9 million new cases of dementia worldwide are predicted each year [5] as populations around the globe continue to live longer [6]. These figures could be very much under estimated as it is widely accepted that between 50 and 80% of people affected have no formal dementia diagnosis [7]. This growing epidemic effects not only the individuals living with dementia, but also their families caring for them, the communities they live in and the health care systems they rely upon.…”

Section: Introductionmentioning

confidence: 99%

Disrupted sleep and associated factors in Australian dementia caregivers: a cross-sectional study

et al. 2020

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Background: Sleep disturbance is an issue reported by caregivers. Waking at night is a feature of dementia and by proxy, sleep disturbance among caregivers is reported to be high. Little is known about the characteristics of dementia caregivers' sleep and the factors that may influence sleep disruption. The purpose of this study was to investigate the sleep characteristics and disturbances of Australian caregivers of a person living with dementia. In addition, it evaluated the psychological wellbeing of caregivers by evaluating associations between mood and sleep in this population. Methods: This study used a cross-sectional, descriptive, correlation design. Participants were recruited with the assistance of Alzheimer's Australia, Dementia Australia and targeted social media advertising. In total, 104 adult, primary, informal caregivers of people with dementia participated, completing a questionnaire on demographic characteristics, the Depression, Anxiety and Stress Scale (DASS-21) and the Pittsburgh Sleep Quality Index (PSQI). Results: In this study, 76% of caregivers were female who had been caring for someone living with dementia on average for 4.8 years. 44% of participants had two or more co-morbidities namely cardiovascular disease, osteoarthritis and diabetes. 94% of participants were poor sleepers with 84% with difficulty initiating sleep and 72% reporting having difficulty maintaining sleep. Overall, psychological distress was common with high levels of moderate to severe depression, anxiety and stress. Global PSQI scores were significantly positively associated with depression and anxiety, with the strongest correlation seen with stress scores. Depression scores were also moderately associated with daytime dysfunction. Stress was identified as a significant predictor of overall sleep quality. Conclusions: Sleep problems are common within the population of dementia caregivers. Due to the nature and duration of caregiving and the progression of dementia of the care recipient, there is the potential for a decline in the caregivers' mental and physical health. Caregivers of those living with dementia are more likely to have comorbidities, depression, anxiety and stress. Sleep quality is correlated with emotional distress in dementia caregivers although the direction of this association is unclear. Therefore, sleep and psychological wellbeing may be intertwined, with improvements in one aspect resulting in a positive impact in the other.

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“…• Reducing specialling saves money • Opportunities • Real-time debriefing/huddles (Ahern et al, 2018) Prospective cohort study.…”

Section: Themes -Antecedents (What Happens Before?)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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Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Cited by 7 publications

References 39 publications

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

Disrupted sleep and associated factors in Australian dementia caregivers: a cross-sectional study

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

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