The impact of a hospital-based special care unit on behavioural and psychological symptoms in older people living with dementia

Abstract

Background Hospital patients with behavioural and psychological symptoms of dementia (BPSD) are vulnerable to a range of adverse outcomes. Hospital-based Special Care Units (SCUs) are secure dementia-enabling environments providing specialised gerontological care. Due to a scarcity of research, their value remains unconfirmed. Objective To compare hospital based SCU management of BPSD with standard care. Design Single-case multiple baseline design. Setting and participants One-hundred admissions to an 8-bed SCU over 2 years in a large Australian public hospital. Methods Repeated measures of BPSD severity were undertaken prospectively by specialist dementia nurses for patients admitted to a general ward (standard care) and transferred to the SCU. Demographic and other clinical data, including diagnoses, medication use, and care-related outcomes were obtained from medical records retrospectively. Analysis used multilevel models to regress BPSD scores onto care-setting outcomes, adjusting for time and other factors. Results When receiving standard care, patients’ BPSD severity was 6.8 (95% CI 6.04–7.64) points higher for aggression, 15.6 (95% CI 13.90–17.42) points higher for the neuropsychiatric inventory, and 5.8 (95% CI 5.14–6.50) points higher for non-aggressive agitation compared to SCU. Patients receiving standard care also experienced increased odds for patient-to-nurse violence (OR 2.61, 95% CI 1.67–4.09), security callouts (OR 5.39 95% CI 3.40–8.52), physical restraint (OR 17.20, 95% CI 7.94–37.25) and antipsychotic administration (OR 3.41, 95% CI 1.60–7.24). Conclusion Clinically significant reductions in BPSD and psychotropic administration were associated with SCU care relative to standard ward care. These results suggest more robust investigation of hospital SCUs, and dementia-enabling design are warranted.