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P18. Acute and hospital care

Detailed programme and abstracts

P18.1. The Village Landais: an new innovating and caring structure in south-west of France

GALIBERT Vincent

GIP Village Landais Alzheimer, Dax, France

Few years ago, the Landes Department, decided to launch a new way to care for people with Alzheimer’s diseases. First of its kind in France, second in Europe, the Village Landais, in Dax, will be a new facility where people suffering for Alzheimer’s diseases will go on living « like at home ».

The Village Landais will be a white-coat free zone with a non-drug approach within a secure environment in small housing units. It will house 120 residents, including 10 under-60s, supported by 120 staff and 120 volunteers. 12 places for people suffering from Alzheimer will be available in a day-care unit. The role given to families will be paramount, from setting the private rooms with their dear one’s own pieces of furniture, to the monitoring of the residents welfare.

The architecture is set up to be like a real village from the Landes’ countryside so that the residents will live in an environment they identify with and feel safe in. The Bastide, central square of the structure, will contain a restaurant, an auditorium, an multimedia library, a hairdresser salon, a health center and a small food store. All of these equipments will be accessible for inhabitants of Dax city. Residents will be living in a wide natural setting as they can freely wander in the 5 hectares park.

Residents will live in 7 or 8 people houses. Each neighborough, of 4 houses each, will have its own characteristics inspired by different areas from the Landes Departement.

The Village will also be a resource center for medical and therapeutic research. Several evaluation studies will be conducted to measure the exemplary and effective nature of this innovative structure. All the medical, medico-social actors and careres as well will be able to find additional support or new models of care.

P18.2. Before the end of life in patients with Alzheimer's disease

IOANCIO IOANA, SPIRU LUIZA

Elias EmergencyHospital, Bucharest, Romania

Alzheimer’s disease is considered a neurocognitive disease with a slow evolution, experiencing a plateau in development when patients have been diagnosed early, have followed a closely monitored treatment and have been constantly clinically reevaluated. Support, both medical and from the family of the patient, are the key for a prolonged evolution of this irreversible illness.

Aims: Our study`s primary objective was the gerontopsychiatric evaluation of the final period of life of patients with Alzheimer’s disease, within the acute and hospital care cadre.

Methods: Our study was fulfilled in the Memory Clinic, Elias University Emergency Hospital, Bucharest, Romania, in the years 2017-2020. 117 patients diagnosed with Alzheimer’s disease, 77% women and 23% men, aged 72 years and over were enrolled in the study using international diagnostic criteria. We evaluated the patients as well as yearly and the next three years follow-up.

Subject evaluation was performed by a complex neuropsychological battery: Standardized Geriatric Evaluation.

Results: In the final months of life, patients admitted to our clinic have described three kinds of evolution. In one group, patients have resignedly looked towards the end, expressing requests to return “home”, in the company of their closest relative and with their favourite food. Another group has presented episodes of delirium, with psychomotor agitation and reversal of their sleep-alert schedule. The majority of patients met their end through comorbidities: sepsis, strokes, cancer or cardiovascular pathologies.

Conclusions: Patients with Alzheimer’s disease that are correctly treated and monitored meet their end through different pathologies, the most frequent being intercurrent infections, respectively sepsis. In the brief moments of lucidity, they evoke the image of their home.

P18.3. Cultures of care and the work of communicating the ‘rules of the ward’ to people living with dementia during a hospital admission and its consequences

FEATHERSTONE Katie1, NORTHCOTT Andy2

1Cardiff University, Cardiff, United Kingdom, 2De Montfort University, Leicester, United Kingdom

This paper examines the everyday cultures of care within hospital wards and the consequences for people living with dementia during an acute admission. It draws on a 5 year program of hospital ethnography (supported by the UK Department of Health via the National Institute for Healthcare Research) within acute wards in 8 hospitals across England and Wales, to provide a detailed examination of ward strategies and staff approaches to the care of this significant patient group at the bedside. 

Across these wards, we observed the rehearsal and duplication of a remarkably stable interactional performance during the routines of bedside care. Across these encounters, ward staff focussed on communicating the ‘rules of the ward’. The hospital ward is a site which has its own culture, and an established but unwritten set of “rules” that must be understood and learnt by all those entering it. Although these rules applied to all, we found their explicit reinforcement and emphasis in their communication to people living with dementia. A limited range of patient responses were viewed as acceptable and in accordance with these organisational rules. Failure to comply with these tacitly established rules could often have negative impacts for the person living with dementia.

We explore these ‘rules’ and their enactment and reinforcement, to provide ways of uncovering aspects of ward cultures, the social standing and understandings of people living with dementia, and the recognition and attribution of this diagnostic category during an acute admission. 

P18.4. 10 years of Alzheimer Scotland Dementia Nurse Consultants: building bridges between Scottish Government, the NHS and the charitable sector

SKINNER Helen1, MASTERS Hugh2, MCCRIMMON Tilda3

1NHS Fife, Kirkcaldy, United Kingdom, 2Alzheimer Scotland, Edinburgh, United Kingdom, 3NHS 24, Glasgow, United Kingdom

Background: Since 2011, Alzheimer Scotland, Scottish Government, and every NHS Health Board in Scotland have been collaborating to fund a Nurse Consultant (ASDNC) post focused on acute hospital care in every region in Scotland.

Aim: Through individual and collective responsibility, the key aim of the Nurse Consultants was to deliver the commitments in Scotland’s National Dementia Strategies which called for action to improve the experience of people with dementia, their families and carers in acute care and specialist dementia settings.

Objectives:

  • To implement the 10 Dementia Care Actions in Hospital;
  • To shift the paradigm of care for people with dementia in hospital settings;
  • To develop actions to reduce delayed discharges, avoidable admissions and inappropriately long stays in hospital and demonstrate impact;
  • To influence and advise on national dementia policies and strategies.

Participants/methods: This presentation draws on the key reports, achievements and impact areas of the Alzheimer Scotland Dementia Nurse Consultant group from 2015-2020, including during the COVID-19 pandemic, and sets out a dynamic action plan for future improvements. 

Key Findings: The presentation highlights:

  • The value of a co-ordinated national high-level nurse consultant group;
  • The need for a multi-pronged approach and the value of working with the 1000 Dementia Champions in Scotland;
  • The improvements to the experience of care for each of the 10 dementia care actions for hospital across the domains of Nurse Consultants: expert practice, professional leadership and consultancy, education training and development, and practice and service development;
  • The value of a specific ASDNC focus on NHS24 emergency and crisis care.

Conclusion: Whilst there is clear evidence of improvement associated with the role of the ASDNC there remain significant system challenges to reducing delayed discharges, avoidable admissions and inappropriately long stays in hospital.

P18.5. Nurses' experiences of delivering acute orthopaedic care to patients with dementia

JENSEN Anders Møller1, HOUNSGAARD Lise2, WILSON Rhonda3, PEDERSEN Birthe2, OLSEN Rolf4

1VIA University College, Holstebro, Denmark, 2University of Southern Denmark, Odense, Denmark, 3The University of Newcastle, Ourimbah, Australia, 4-, Odense, Denmark

Background and aim: Nurses who care for acute patients with dementia in a hospital setting report a variety of challenges in regard to meeting the complex needs of their patients, but little attention have been given to care in the orthopaedic wards. This study investigates nurses’ experiences of caring for people with dementia, in an acute orthopaedic hospital ward setting.

Methods: This qualitative study employs hermeneutic phenomenological research methods. Eight Danish nurses were interviewed in an orthopaedic ward about their experiences in caring for orthopaedic patients with dementia. Nurses with various levels of expertise were selected for interview so that a full range of nursing experiences could inform the research study. The interviews followed an intense participant observation period at the ward.

Results: The results of the study revealed two major themes: “Nurse communication and patient information” and “Care compromise”, with three and four sub‐themes, respectively. These findings are used to illustrate how, and why, nurses’ experiences of caring for patients with dementia contribute a discontentment and negative preconceived perception by some nurses towards their acute care of patients with dementia. The results are discussed in the context of Interactional Nursing Practice theory and describe the challenges experienced by acute care orthopaedic nurses who care for patients with dementia.

Conclusion: Orthopaedic nurses find it challenging and professionally difficult to provide person‐centred care for patients with dementia during an acute orthopaedic hospital admission. Orthopaedic nurses should work to adopt a positive attitude, and person‐centred approach, towards dementia care. It is also recommended that the electronic patient record should be supplemented by oral dissemination to some extent, as information, plans of action and knowledge about the care situation for patients with dementia tends to drown in chronological data presentation.

 

 
 

Last Updated: Thursday 24 September 2020

 

 
  • Acknowledgements

    The 30th AE Conference received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe gratefully acknowledges the support of all conference sponsors.
  • European Union
  • Roche
 
 

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