This article reports on work to develop and evaluate best practice in the acute medical care of older people with cognitive impairment in general hospitals.
600 confused patients aged over 65 admitted for acute medical care into large acute general hospital in the United Kingdom were allocated randomly to either a specialist medical and mental health unit (both designed to deliver best practice care for people with delirium or dementia) or to standard acute care (acute geriatric or general medical wards).
“The specialist units featured staffing by medical and mental health professionals; enhanced staff training in delirium, dementia, and person centred dementia care; provision of organised purposeful activity; environmental modification to meet the needs of those with cognitive impairment; delirium prevention; and a proactive and an inclusive approach to family carers”.
The number of days spent at home over the 90 days after hospitalisation were counted, and structured non-participant observation studies took place to assess patients’ experiences and the satisfaction of family carers with hospital care.
This study found no significant difference in the number of days spent at home between the two groups. Other quantitative measures showed little difference between the two groups: the median index hospital stay was 11 versus 11 days, mortality was 22% versus 25%, readmission was 32% versus 35%, although new admissions to care homes was 20% versus 28% for the specialist units and standard care groups respectively. Patients returning home spent 70.5 at home versus 71.0 days.
The softer, qualitative, measures of care did indicate differences however. Patients on the specialist units spent significantly longer time with a positive mood and / or engagement and experienced more interactions with staff to meet their emotional and psychological needs. Family carers were more satisfied with the care, and levels of severe dissatisfaction with care were reduced.
“Best practice acute hospital management of older people with delirium and dementia does not improve health status or reduce use of hospital resources”.
The authors conclude that while specialist care for people with delirium and dementia may improve the experience of patients and the satisfaction of carers, there are no significant (measurable) outcomes in terms of improvements to health status or reduced service use. It is acknowledged in the article that patients’ experiences and carers’ satisfaction are important when assessing the care of frail older people.
Goldberg, SE. Bradshaw, LE. [and] Kearney, FC. [et al] (2013). Care in specialist medical and mental health unit compared with standard care for older people with cognitive impairment admitted to general hospital: randomised controlled trial (NIHR TEAM trial). BMJ (Clinical Research ed.), July 2nd 2013, 347, f4132. (Click here to view the PubMed abstract).
[A version of this item features in Dementia: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 8, July 2013].