Geriatric Patients With Cognitive Impairment

Renteln-Kruse, Wolfgang von; Neumann, Lilli; Klugmann, Björn; Liebetrau, Andreas; Golgert, Stefan; Dapp, Ulrike; Frilling, Birgit

doi:10.3238/arztebl.2015.0103

Cited by 17 publications

(9 citation statements)

References 82 publications

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“…As would be expected, hospitalized older patients with dementia are prone to be prescribed five or more medications daily [41,100], which are associated with higher co-morbidities and greater demented-related complications [33,40]. In accordance to the study of Brunet et al and Von-Ranteln Kruse et al, between 82-98% of hospitalized older people living with dementia experienced polypharmacy [55,56]. With regard to factors associated with polypharmacy, a higher number of prescribed medication in cardiac therapy, psycholeptics and psychoanaleptics were revealed.…”

Section: Plos Onementioning

confidence: 83%

Drug related problems in older adults living with dementia

et al. 2020

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Background Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. Methods In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. Results Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. Conclusions The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events

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Section: Plos Onementioning

confidence: 83%

Drug related problems in older adults living with dementia

et al. 2020

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“…Additional factors that supported therapy staff to work flexibly included training in dementia care, reduced patient lists and treatment rooms located on the ward. 64 …”

Section: Resultsmentioning

confidence: 99%

Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

2017

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ObjectivesTo identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.DesignA realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.Data sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.Eligibility criteriaStudies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.ResultsPhase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.ConclusionsThis review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.Trial registration numberCRD42015017562.

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“…Independent from these factors, the special care ward itself shows the strongest impact on QoL, indicating that patients with dementia explicitly benefit from specialised care concepts. Other studies also report these benefits, both in a nursing home or hospital setting 54 55. Since we controlled for patient characteristics such as main diagnosis, age, functional limitations, chronic comorbidities, agitation, length of stay and so on in our model, we do not assume that the positive effect of the special care ward is completely a result of a biased sample between the intervention and the control group.…”

Section: Discussionmentioning

confidence: 99%

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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Geriatric Patients With Cognitive Impairment

Cited by 17 publications

References 82 publications

Drug related problems in older adults living with dementia

Drug related problems in older adults living with dementia

Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

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

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