A scoping review of crisis teams managing dementia in older people

Abstract

BackgroundResearch on crisis teams for older adults with dementia is limited. This scoping review aimed to 1) conduct a systematic literature review reporting on the effectiveness of crisis interventions for older people with dementia and 2) conduct a scoping survey with dementia crisis teams mapping services across England to understand operational procedures and identify what is currently occurring in practice.MethodsFor the systematic literature review, included studies were graded using the Critical Appraisal Skills Programme checklist. For the scoping survey, Trusts across England were contacted and relevant services were identified that work with people with dementia experiencing a mental health crisis.ResultsThe systematic literature review demonstrated limited evidence in support of crisis teams reducing the rate of hospital admissions, and despite the increase in number of studies, methodological limitations remain. For the scoping review, only half (51.8%) of the teams had a care pathway to manage crises and the primary need for referral was behavioral or psychological factors.ConclusionEvidence in the literature for the effectiveness of crisis teams for older adults with dementia remains limited. Being mainly cohort designs can make it difficult to evaluate the effectiveness of the intervention. In practice, it appears that the pathway for care managing crisis for people with dementia varies widely across services in England. There was a wide range of names given to the provision of teams managing crisis for people with dementia, which may reflect the differences in the setup and procedures of the service. To provide evidence on crisis intervention teams, a comprehensive protocol is required to deliver a standardized care pathway and measurable intervention as part of a large-scale evaluation of effectiveness.

Developing a model of best practice for teams managing crisis in people with dementia: A consensus approach

“…An additional scoping survey of TMCDs in the UK was undertaken to provide a picture of current TMCD service delivery. Results of the systematic review and scoping survey are published elsewhere [5].…”

“…This is underpinned by a desire to maintain and enhance independence for people with dementia, in order to improve their quality of life and that of their carers [2], and to reduce the financial costs associated with admission to acute settings [3,4]. Specific community-based services, typically operating within a Home Treatment Team model, exist to support people with dementia and their carers during times of crisis when the ability to remain independent is compromised and an admission to hospital is a likely outcome [5]. Such situations often arise due to a change or deterioration in physical and/or mental health function of the person with dementia, or a breakdown in care being provided by either formal or informal carers.…”

“…A recent systematic review and scoping survey revealed that TMCDs vary greatly in several aspects such as their titles, eligibility criteria, model of working, and approach to crisis resolution or prevention [5,6]. Neither policy documents nor commissioning guidance provide exact details on how TMCDs, or any form of crisis resolution service for people over the age of 65 or for people specifically with dementia, should be designed or implemented [7].…”

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

“…25,26 However, the evidence for innovative mental health care strategies for elderly people is scarce. 27 Most studies using ACT, [28][29][30] HT, [31][32][33][34][35] or CRT [36][37][38] did not specifically report whether the innovative care models reduced AHLS in geriatric populations with mental health care needs. A British study showed that CRT and HT significantly reduced admissions of elderly mentally ill patients, but there was no significant difference in AHLS as compared before and after the introduction of these services.…”

Developing a model of best practice for teams managing crisis in people with dementia: A consensus approach

“…Speci c community-based services exist to support people with dementia and their carers during times of crisis when their ability to remain independent is compromised and inpatient admission to hospital likely . Referral routes to these services vary, and service models include: stand-alone crisis services, often called Crisis Home Treatment Teams, or crisis services embedded within community services with a broader remit, such as community Mental Health Teams or Memory Assessment Services (5). Such situations often arise due to a change or deterioration in physical or mental health function of the person with dementia, or a breakdown in care .…”