Enhancing hospital care of patients with cognitive impairment

Abstract

Purpose The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers' expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery. Design/methodology/approach A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses ("specials"), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken. Findings There was a significant reduction in number of falls and number of patients allocated "specials" over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers ( n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent. Originality/value Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

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

“…In total, 19 articles met the inclusion criteria (see the flow chart in Figure 1). Most of the interventional studies had a before-after design [20][21][22][23][24][25][26][27][28] (n = 9). One was a cluster-randomised controlled trial [29], one used a repeated measures design [30] and three were controlled clinical trials [31][32][33].…”

“…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). Three studies focused on family-/person-centred programmes [22,23,30], and two studies were on specially trained nurses [29,32]. 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).…”

“…Two of the family-centred programmes were based on the 'TOP5 strategy', were staff defines up to five personalised care strategies with the family caregivers to enhance person-centred care [22,23].…”

“…One-to-one nursing care, which is used 'in cases where regular staffing levels are not equipped to provide care, leaving the patient, other patients or staff at risk of negative outcomes' [23], decreased significantly in two studies [22,23].…”