What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature

Abstract

Background: Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment. Conclusion: The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.

Characteristics of dementia-friendly hospitals: an integrative review

“…We identified six characteristics of DFHs: continuity , person-centeredness , consideration of phenomena within dementia , environment , valuing relatives and knowledge and expertise . These characteristics address the needs of patients with dementia, their relatives and healthcare professionals as identified in other studies [ 15 , 16 , 58 – 61 ]. In particular, person-centeredness is a central topic in other studies that interviewed patients with dementia and their relatives.…”

Can person-centred care for people living with dementia be delivered in the acute care setting?

“…Aspects of hospital culture that need to change include building workforce capacity to meet both psychological and physical needs of people living with dementia, creating physical environments that support familiarisation and social interactions, having an inclusive approach to carers and developing a culture of sharing knowledge and information across hierarchies and roles. Our conclusions were echoed by Røsvik and Rostad [ 8 ], whose review of what best meets the needs of people with dementia in hospitals also highlighted a lack of research into models of care that best support the psychosocial needs of people living with dementia.…”

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions

“…We did not find a study conducted with PlwD at home and only one PC-intervention study at a hospital. Two recent systematic reviews [88,89] focused their research on needs of PlwD and registered nurses' experiences with PCC in the hospital setting. As there is an aim by policy makers to move care delivery to the home [90] and many aged people prefer to receive care at home [91], this setting should find greater consideration in future investigations about PCC and PC-interventions.…”