Investigation into attitudes towards older people with dementia in acute hospital using the Approaches to Dementia Questionnaire

Abstract

Background Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. Methodology A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the ‘Approaches to Dementia Questionnaire’; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Results Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Conclusion Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice.

Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes

“…However, whilst these studies 41,42 found that the attitude of hospital staff was associated with their occupation, this was not found in our study, possibly due to the smaller sample size. Moreover, the relationship between decreasing attitude score and increasing age, has also been found in some studies 42,43 but not in others 41 . Staff attitude scores were significantly related with their experience of working with persons with dementia.…”

“…Similar to other studies, 41,42 the attitude of hospital staff towards persons with dementia was in general positive; although there was a significant variation according to gender (female staff reported more positive attitudes), age (the younger the age the better the attitudes) and how they rated their personal experience of working with these persons (staff perceiving more positive experience having better attitudes). However, whilst these studies 41,42 found that the attitude of hospital staff was associated with their occupation, this was not found in our study, possibly due to the smaller sample size. Moreover, the relationship between decreasing attitude score and increasing age, has also been found in some studies 42,43 but not in others 41 .…”

Acute hospital staff’s attitudes towards dementia and perceived dementia knowledge: a cross-sectional survey in Ireland

“…Our findings in hospital staff indicated a largely positive attitude towards people living with dementia with a mean ADQ score of 70.64, comparable to the research findings in similar settings (acute hospital, mean ADQ score of 71.44, [47]; acute medical and orthopaedic wards, mean ADQ score of 72.7, [48] and different settings (nursing homes and hospital geriatric wards, mean ADQ score of 70.4, [36] . More specifically, the general positive attitude found in our study had a higher emphasis on person-centred attitudes than on the hope attitude which is in line with previous findings [24,25,36,38,45,49,50].…”

Dementia education in acute hospitals

“…Apart from these troubling features of acute hospital admission for people with dementia, they experience misunderstanding and misdiagnosis due to lack of staff skills for communication with people with cognitive impairment (O'Brien, 2019), pathologizing of normal reactions to abnormal situations (Hunter et al, 2013), and negative attitudes and behavior from acute hospital staff (de Vries et al, 2019;Scerri et al, 2020). And they occupy a quarter of the beds in acute hospitals (Featherstone et al, 2019).…”

“…There has been an awareness of this problem for several decades. However, due to growing numbers of people with dementia utilizing acute hospitals and a growing societal awareness and self-advocacy of people with dementia (Bryden, 2005;Swaffer, 2015), there is now an effort and the political will to do something about it.…”