How empowering is hospital care for older people with advanced disease?

Selman, L.E. et al .(2017) Age Ageing. 46(2) pp. 300-309.

Background: patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care.

Conclusions: empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff–patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.

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The management of behavioural and psychological symptoms of dementia in the acute general medical hospital

White, N. et al. (2017) International Journal of Geriatric Psychiatry. 32(3) p. 297-305

Background: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals.

Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.

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Caring for people with dementia in hospital

Tropea, J. et al. (2017) International Psychogeriatrics. 29(3)pp. 467-474

Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care.

A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low.

 

The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

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Behavioural and psychological symptoms in patients with dementia, distress for nursing staff and complications in care

Hessler, J. B. et al. (2017) Source Epidemiology and psychiatric sciences (01) p. 1-10

Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.

BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.

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Increased risk of dementia in patients hospitalized with acute kidney injury

Tsai, H. et al. (2017) PloS one. 12(2) p. e0171671

Purpose: To determine whether acute kidney injury (AKI) is a risk factor for dementia.

Conclusions: We found that patients with AKI exhibited a significantly increased risk of developing dementia. This study provides evidence on the association between AKI and long-term adverse outcomes. Additional clinical studies investigating the related pathways are warranted.

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Exploring the impact of dementia-friendly ward environments on the provision of care

Brooke, J. & Semlyen, J. Dementia. Jan 2017 ; p. 1471301216689402

Dementia-friendly wards are recent developments to improve care for patients with dementia in acute hospitals. This qualitative study used focus groups to understand the impact of dementia friendly ward environments on nurses experiences of caring for acutely unwell patients with dementia. Qualified nurses and health care assistants working in an acute NHS Trust in England discussed their perceptions and experiences of working in a dementia-friendly ward environment.

Four themes developed from the thematic analysis:

1. ‘It doesn’t look like a hospital’: A changed environment,
2. ‘More options to provide person-centred care’: No one size fits all,
3. ‘Before you could not see the patients’: A constant nurse presence and
4. ‘The ward remains the same’: Resistance to change. Recommendations and implementations for practice are discussed.

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Dance movement therapy for dementia

Karkou, V & Meekums, B. (2017) Cochrane Database of Systematic Reviews. Issue 2. Art. No.: CD011022

Background: Dementia is a collective name for different degenerative brain syndromes which, according to Alzheimer’s Disease International, affects approximately 35.6 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes.

At the same time, there is growing literature that highlights the capacity of the arts and embodied practices to address this complexity. Dance movement therapy is an embodied psychological intervention that can address complexity and thus, may be useful for people with dementia, but its effectiveness remains unclear.

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Management of rapid cognitive decline due to Alzheimer’s disease

Jia, J. et al. Alzheimers & Dementia. Published online: 23 February 2017

Introduction: Rapid cognitive decline (RCD) occurs in dementia due to Alzheimer’s disease (AD).

Discussion: RCD is sufficiently common to interfere with randomized clinical trials. We propose a 6-month prerandomization determination of the decline rate or use of an RCD risk score to ensure balanced allocation among treatment groups.

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Older people miss out on psychological therapies

Depression in older people is common, under-diagnosed, under-treated and attracts “therapeutic nihilism”, according to Professor Alistair Burns, NHS England’s National Clinical Director for Dementia | OnMedica

Prof Burns say while one in five older people have clinical depression, “contrary to some popular and professional opinion, it is eminently treatable”. He wants clinicians to offer a wider range of treatments and therapies to target depression and anxiety which are both associated with increased risk of more serious physical and mental health problems.

“Treatments for depression in older people are largely the same as in younger people and there is high quality and convincing evidence that older people respond very well to interventions,”

While exercise is a “very effective” treatment for depression, Prof Burns cites the Health Survey for England which showed that only 18% of men and 19% of women aged 55-64 undertake the recommended amount of regular exercise, a figure falling to 10% and 2% for people aged 75-85.

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Cognitive Training Interventions for Patients with Alzheimer’s Disease

Kallio, E-L. et al. (2017) Journal of Alzheimer’s Disease. 56(4): 1349

Background: Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear.

Conclusions: Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer’s disease.

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