Best practice for the management of older people with dementia in the acute care setting: a review of the literature (original) (raw)
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Journal of Clinical Nursing, 2013
Aims and objectives. To explore the responses of healthcare professionals to the admission of people with cognitive impairment to the acute hospital setting. Background. While improving care for people with dementia has been identified as a national priority, providing appropriate care in acute hospitals for people with comorbid cognitive impairment presents challenges to healthcare professionals. Design. Based on the principles of ethnography, this was a qualitative interview and nonparticipation observational study. Methods. Seventy-two hours of nonparticipant observations of care together with semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had a cognitive impairment. Interviews and observations were conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. Results. The results identified a core problem, 'disruption', and a core process, 'gaining or giving a sense of control to cope with disruption'. Healthcare professionals respond to the disruption in three ways: by acting to preserve the personhood of the individual; by seeking to protect themselves from the stresses associated with caring for the person with cognitive impairment; and by suspending the personhood of the individual. Conclusion. Where healthcare professionals acted to suspend the personhood of the patient, they appeared to be demonstrating signs of 'burnout'. Relevance to clinical practice. There is a need both to challenge poor practice and for positive development work with healthcare professionals who work in acute hospitals with people with dementia and cognitive impairment so that they are equipped with the skills, emotional resilience and organisational support to be effective in meeting the needs of people with dementia and cognitive impairment.
BMC Geriatrics, 2021
BackgroundCognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care.MethodsThe analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depress...
The Effect of Dementia on Acute Care in a Geriatric Medical Unit
International Psychogeriatrics, 1992
Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients.Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an ad...
Caring for elderly patients with dementia: nursing interventions
Nursing: Research and Reviews, 2013
Elderly patients suffering from chronic cognitive decline/dementia are susceptible to poor quality of care which further erodes their quality of life. Seemingly benign events can create cascade iatrogenesis in those whose compensatory ability is compromised by impairments in multiple domains. Under recognition, misrecognition, or failure to intervene and manage this vulnerable population leads to suboptimal care. This places them at risk for cognitive decline, functional decline, and challenging behaviors, creating financial and emotional burdens for not only the patients but also family, staff, and organizations that are attempting to provide care. Identifying, managing, and therapeutically responding to confused elderly is complex. Recognizing the challenges makes the development of tools that guide comprehensive assessment planning, interpretation of findings, and treatment plans imperative. Innovative and effective assessment and interventional approaches are present in the literature. This article synthesizes the scientific evidence to guide clinicians to implement in practice.