(In-)formal caregivers’ and general practitioners’ views on hospitalizations of people with dementia - an exploratory qualitative interview study

Abstract

BackgroundDementia is an irreversible chronic disease with wide-ranging effects on patients’, caregivers’ and families’ lives. Hospitalizations are significant events for people with dementia. They tend to have poorer outcomes compared to those without dementia. Most of the previous studies focused on diagnoses leading to hospitalizations using claims data. Further factors (e.g. context factors) for hospitalizations are not reproduced in this data. Therefore, we investigated the factors leading to hospitalization with an explorative, qualitative study design.MethodsWe interviewed informal caregivers (N = 12), general practitioners (GPs, N = 12) and formal caregivers (N = 5) of 12 persons with dementia using a semi-structured interview guideline. The persons with dementia were sampled using criteria regarding their living situation (home care vs. nursing home care) and gender. The transcripts were analyzed using the method of structuring content analysis.ResultsAlmost none of the hospitalizations, discussed with the (in-)formal caregivers and GPs, seemed to have been preventable or seemed unjustifiable from the interviewees’ points of view. We identified several dementia-specific factors promoting hospitalizations (e.g. the neglect of constricted mobility, the declining ability to communicate about symptoms/accidents and the shift of responsibility from person with dementia to informal or formal caregivers) and context-specific factors promoting hospitalizations (e.g. qualification of nursing home personal, the non-availability of the GP and hospitalizations for examinations/treatments also available in ambulatory settings). Hospitalizations were always the result of the interrelation of two factors: illnesses/accidents and context factors. The impact of both seems to be stronger in presence of dementia.ConclusionsPoints for action in terms of reducing hospitalization rates were: better qualified nurses, a 24-h-GP-emergency service and better compensation for ambulatory monitoring/treatments and house calls. Many hospitalizations of people with dementia cannot be prevented. Therefore, hospital staffs need to be better prepared to handle patients with dementia in order to reduce the negative effects of hospitalizations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2484-9) contains supplementary material, which is available to authorized users.

Factors influencing hospital admission among patients with autopsy‐confirmed dementia

“…Patients with dementia can become aggressive, and dementia is associated with significantly increased use of psychotropic medication and injuries . These behavioural and psychological symptoms increase the burden placed on caregivers, which can lead to hospital admission . Given the results of the present study, it is reasonable to suppose that BPSD are the risk factors that most influence whether family members and caregivers are able to take care of patients with dementia and, more specifically, BPSD.…”

“…29 These behavioural and psychological symptoms increase the burden placed on caregivers, which can lead to hospital admission. 21,30,31 Given the results of the present study, it is reasonable to suppose that BPSD are the risk factors that most influence whether family members and caregivers are able to take care of patients with dementia and, more specifically, BPSD. A previous study found that speech impairment reduced communication function and resulted in increased caregiver burden.…”

What happens before, during and after crisis for someone with dementia living at home: A systematic review

“…The review also found professional and carer knowledge, skill and beliefs to be important for early risk of harm recognition and knowing what can be done. Studies investigating the reasons for hospitalisation in people with dementia similarly report both carer and healthcare professional beliefs about the potential for prevention of unplanned hospital admissions influence pre-crisis intervention (Pohontsch, Scherer, & Eisele, 2017). Bowen et al (2011)'s study collected data from carers and evidenced people with dementia may have no recollection of a past crisis, as their carers reported 'that they did not realise that they were missing.'…”

“…During crisis, current practice may fail to consider the full range of biopsychosocial interventions. The broader literature demonstrates that emergency departments may ignore underlying psychosocial factors contributing to a physical health crisis (Onen et al., 2001), appropriate services are not always available to offer biopsychosocial support in the community (Jennings et al., 2018; Pohontsch et al., 2017; Purdy, Griffin, Salisbury, & Sharp, 2010) and primary care staff may not know what services are available (Jennings et al., 2018). Furthermore, when fewer community resources are available, the demand on emergency department increases, particularly in those with cognitive impairment (D’Souza, James, Szafara, & Fries, 2009).…”

„… darum rufe ich jetzt den Rettungsdienst!“

“…Insgesamt könnte diesbezüglich eine Steigerung von Verbindlichkeit der hausärztlichen Versorgung in Pflegeheimen (z. B. konstante Erreichbarkeit von hausärztlichen Praxen, reguläre Heimvisiten) Abhilfe schaffen, um vermeidbare oder unerwünschte Krankenhauszuweisungen von Bewohner_innen zu reduzieren (Marshall, Clarke, Peddle & Jensen, 2015;Pohontsch, Scherer & Eisele, 2017…”