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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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