What is the current state of care for older people with dementia in general hospitals? A literature review

Abstract

This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care.

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

“…Seven 72,92,102,125,132,148,162 were qualitative studies, one 107 was a mixed study including a review and a qualitative study, three 93,99,153 were reviews and two 20,94 were questionnaire studies. Three studies 20,94,102 focused on people with dementia and diabetes, two 72,93 focused on those with dementia and VI, one 89 looked at those with dementia and deafness, one 92 focused on those with dementia and cancer, two 148,153 looked at family carers' views on medication management and four 99,107,125,132 looked at the needs of people with dementia in general hospitals. Literature on the experiences of older people with dementia in acute general hospitals has highlighted shortcomings in the care provided, the attitudes and training of staff, and the physical environment and problems with care cultures.…”

“…Literature on the experiences of older people with dementia in acute general hospitals has highlighted shortcomings in the care provided, the attitudes and training of staff, and the physical environment and problems with care cultures. 99,107,125 Poor communication is a major barrier to the provision of good care for people with dementia and a comorbid health condition. 72,99,107 Practitioners reported that they found it difficult to communicate with PLWD and communication difficulties were compounded when PLWD had additional comorbidities that made communication difficult, such as hearing loss or sight loss.…”

“…99,107,125 Poor communication is a major barrier to the provision of good care for people with dementia and a comorbid health condition. 72,99,107 Practitioners reported that they found it difficult to communicate with PLWD and communication difficulties were compounded when PLWD had additional comorbidities that made communication difficult, such as hearing loss or sight loss. 72,89,92 There were also problems with communication between different professionals and specialist teams, with a lack of co-ordinated working between practitioners in different specialities.…”

Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study

“…In a systematic review of evidence Hanson (2014) found that while many variables contribute towards nurses' attitudes towards older people, studies indicate a strong correlation between negative attitude and insufficient knowledge. Similarly Dewing and Dijk (2014) highlight that poor outcomes for people with dementia in acute hospitals result from a tension between prioritising medical treatment versus the delivery of person-centred dementia care, exacerbated by the fact there is insufficient understanding of what person-centred care is and a lack of staff knowledge and skills to deliver such care. This is supported by Nolan (2006) who found acute hospital nurses in Ireland expressed a desire to care for people with dementia in a person-centred way, but lacked the knowledge to base such care on.…”

Using appreciative inquiry to implement person-centred dementia care in hospital wards

“…One quarter of hospital beds in the UK is estimated to be used by persons with dementia over the age of 65 (Alzheimer Society, 2009). However, the quality of dementia care in these settings is not optimal (Dewing & Dijk, 2014) and can be challenging (Clissett, Porock, Harwood & Gladman, 2013). Alzheimer Society UK (2009) reported that persons with dementia in hospitals stay longer than other patients without dementia, during which time their physical and cognitive status deteriorates whilst long-term institutionalization and the use of anti-psychotic medication becomes more likely.…”