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Specialized care helps patients with dementia

Tuesday August 27, 2013
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Older adult patients with dementia or delirium had the same health outcomes after care in a specialized unit compared with a traditional hospital unit, but those in the specialized unit appeared to have a better experience and patientsí caregivers were more satisfied, according to a recent British study.

The findings, which were published July 2 on the website of the British Medical Journal, focused on 600 patients older than 65 who were characterized as "confused" upon admission for acute medical care at a large general hospital in the United Kingdom. Researchers from the Queens Medical Centre in Nottingham and the University of Nottingham looked for differences in the primary outcome by measuring the number of days spent at home in the 90-day period after the patient was assigned to a randomized group. Secondary outcomes were based on nonparticipant observations of the patientsí experiences and the satisfaction level of patientsí family caregivers.

For the study, the standard care group members were treated on five acute geriatric medical units and six internal medicine units. The staff had general experience in management of dementia and delirium, and mental healthcare was available to all units by consultation with visiting psychiatrists.

The specialized care unit was a 28-bed acute geriatric medical unit with specialized mental health staff including three RNs, an occupational therapist and twice-weekly visits psychiatrist visits. The unitís staff was trained in recognition and management of delirium and dementia and the delivery of person-centered dementia care, the environment was adapted to serve the population, family caregivers were included in the care approach and there was a schedule of organized therapeutic activities.

There was no statistically significant difference in the number of days spent at home, with a median of 51 days for patients in the specialized care group compared with a median of 45 days for the standard care group. Both groups had a median hospital stay of 11 days. The researchers found the mortality rate was similar, 22% for the specialized care group versus 25% in the standard care group, and so was the rate of readmission, with 32% for those receiving specialized care and 35% for standard care.

What the study did find was patients receiving specialized care spent significantly more time in a positive mood or engagement, 79% versus 68% for those receiving standard care. Patients in the specialized care group also experienced more interactions with healthcare staff that met their emotional and psychological needs; during each observation the specialized care group had a median of four interactions compared with a median of one interaction in the standard care group.

The researchers also found more family caregivers were happy with the care in the specialized unit 91% versus 83% in the standard unit, and severe dissatisfaction was less common, 5% versus 10%. Family caregivers reported more satisfaction with overall care, nutrition, dignity and respect, the needs of confused patients being met and arrangements for discharge, according to the findings.

The authors cited frailty and progression of dementia and underlying diseases as possible factors in the absence of marked improvements in overall health outcomes.

"Mortality was high and not significantly reduced by the intervention, suggesting that many patients were reaching the end of their life, when the objectives of care focus on dignity and positive experience rather than survival and restoration of function," they wrote in the study.

The authors cite a need for future studies to look for smaller differences in health outcomes, but said their findings suggest patientsí experiences and caregiversí satisfaction might be more appropriate measures of success than overall outcomes for frail older people approaching the end of life.

Study: www.bmj.com/content/347/bmj.f4132#alternate


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