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Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study

Published online by Cambridge University Press:  15 July 2009

Tania Zieschang ,
Ilona Dutzi ,
Elke Müller ,
Ute Hestermann ,
Katinka Grünendahl ,
Anke Karin Braun ,
Daniel Hüger ,
Daniel Kopf ,
Norbert Specht-Leible  and
Peter Oster
Tania Zieschang*
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Ilona Dutzi
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Elke Müller
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Ute Hestermann
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Katinka Grünendahl
Affiliation:
Klinikum Ludwigsburg, Ludwigsburg, Germany
Anke Karin Braun
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Daniel Hüger
Affiliation:
Medical Hospital, University of Heidelberg, Germany
Daniel Kopf
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Norbert Specht-Leible
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
Peter Oster
Affiliation:
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
*
Correspondence should be addressed to: Dr. Tania Zieschang, MD, Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Rohrbacher Strasse 149, 69126 Heidelberg, Germany. Phone: +49-6221-3191746; Fax: +49-6221-3191505. Email: [email protected].
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Abstract

Background: Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes.

Methods: The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxon's, McNemar tests, pre-post design).

Results: 332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 ± 8.3 vs. 15.0 ± 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001).

Conclusions: The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.

Keywords

acute care hospitalbehavioral and psychological symptoms of dementia (BPSD)deliriumfunctional declinemodel of geriatric care
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 139 - 146
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Archibald, C. (2003). People with Dementia in Acute Hospitals. Stirling: Dementia Services Development Centre.Google Scholar
Archibald, C. (2007). Menschen mit Demenz in Krankenhäusern. Eine Lern- und Arbeitshilfe für Pflegekräfte. Köln: Kuratorium Deutsche Altershilfe.Google Scholar
Brown, C. J., Friedkin, R. J. and Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatrics Society, 52, 1263–1270.CrossRefGoogle ScholarPubMed
Covinsky, K. E. et al. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illness: increased vulnerability with age. Journal of the American Geriatrics Society, 51, 451–458.CrossRefGoogle ScholarPubMed
Cumming, R. G. et al. (2008). Cluster randomized trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ, 336, 758–760.CrossRefGoogle ScholarPubMed
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
Dinkel, R. H. and Lebok, U. H. (1997). The effects of dementia in German acute care hospitals. Dementia and Geriatric Cognitive Disorders, 8, 314–319.CrossRefGoogle ScholarPubMed
Fick, D. M., Agostini, J. V. and Inouye, S. K. (2002). Delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society, 50, 1723–1732.CrossRefGoogle ScholarPubMed
Fields, S. D., MacKenzie, R., Charlson, M. E. and Sax, F. L. (1986). Cognitive impairment. Can it predict the course of hospitalized patients? Journal of the American Geriatrics Society, 34, 579–585.CrossRefGoogle ScholarPubMed
Flaherty, J. H., Tariq, S. H., Raghavan, S., Bakshi, S., Moinuddin, A. and Morley, J. E. (2003). A model for managing delirious older inpatients. Journal of the American Geriatrics Society, 51, 1031–1035.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Kitwood, T. (1990). The dialectics of dementia: with particular reference to Alzheimer's disease. Ageing and Society, 10, 177–196.CrossRefGoogle Scholar
Landefeld, C. S., Palmer, R. M., Kresevic, D. M., Fortinsky, R. H. and Kowal, J. (1995). A randomized trial of care at a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. New England Journal of Medicine, 332, 1338–1344.CrossRefGoogle Scholar
Lonergan, E., Britton, A. M., Luxenberg, J. and Wyller, T. (2007). Antipsychotics for delirium. Cochrane Database of Systematic Reviews, 2.CrossRefGoogle Scholar
Lyketsos, C. G., Sheppard, J. E. and Rabins, P. V. (2000). Dementia in elderly persons in a general hospital. American Journal of Psychiatry, 157, 704–707.CrossRefGoogle ScholarPubMed
Martin-Cook, K., Hynan, L. S., Rice-Koch, K., Svetlik, D. A. and Weiner, M. F. (2005). Responsiveness of the Quality of Life in Late-Stage Dementia Scale to psychotropic drug treatment in late-stage dementia. Dementia and Geriatric Cognitive Disorders, 19, 82–85.CrossRefGoogle ScholarPubMed
Meagher, D. and Leonard, M. (2008). The active management of delirium: improving detection and treatment. Advances in Psychiatric Treatment, 14, 292–301.CrossRefGoogle Scholar
Naughton, B. J., Saltzman, S., Ramadan, F., Chada, N., Priore, R. and Mylotte, J. M. (2005). A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay. Journal of the American Geriatrics Society, 53, 18–23.CrossRefGoogle ScholarPubMed
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M. and Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346, 1715–1722.CrossRefGoogle ScholarPubMed
Nichols, J. N. (2002). Windows to the heart: creating an Acute Care Dementia Unit. Journal of Palliative Medicine, 5, 181–193.CrossRefGoogle Scholar
Pitkälä, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2005). Prognostic significance of delirium in frail older people. Dementia and Geriatric Cognitive Disorders, 19, 158–163.CrossRefGoogle ScholarPubMed
Reimer, M. A., Slaughter, S., Donaldson, C., Currie, G. and Eliasziw, M. (2004). Special care facility compared with traditional environments for dementia care: a longitudinal study of quality of life. Journal of the American Geriatrics Society, 52, 1085–1092.CrossRefGoogle Scholar
Richard, N. (2003). Zugänge zu Demenzkranken: integrative validation. In Bundesarbeitsgemeinschaft Hospiz, eds. Mit-Gefühlt. Curriculum zur Begleitung Demenzkranker in ihrer letzten Lebensphase (pp. 44–45). Wuppertal: Hospiz-Verlag.Google Scholar
Romero, B. and Wenz, M. (2001). Self-maintenance therapy in Alzheimer's disease. Neuropsychological Rehabilitation, 11, 333–335.CrossRefGoogle Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35, 350–364.CrossRefGoogle ScholarPubMed
Smith, B. (2001). Dementia on a general ward: the benefits of activities. Journal of Dementia Care, 9, 30–31.Google Scholar
Soto, M. E. et al. (2008). Special acute care unit for older adults with Alzheimer's disease. International Journal of Geriatric Psychiatry, 23, 215–219.CrossRefGoogle ScholarPubMed
Vassallo, M., Sharma, J. C., Briggs, R. S. J. and Allen, S. C. (2003). Characteristics of early fallers on elderly patient rehabilitation wards. Age and Ageing, 32, 338–342.CrossRefGoogle ScholarPubMed
von Renteln-Kruse, W. and Krause, T. (2007). Incidence of in-hospital falls in geriatric patients before and after introduction of an interdisciplinary team-based fall-prevention intervention. Journal of the American Geriatrics Society, 55, 2068–2074.CrossRefGoogle ScholarPubMed
Zieschang, T. et al. (2008). A Special Care Unit for acutely ill patients with dementia and challenging behaviour as a model of geriatric care. Zeitschrift für Gerontologie und Geriatrie, 41, 453–459.CrossRefGoogle Scholar