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PO1. Acute and hospital care

Detailed programme, abstracts and poster presentations

PO1.1. Hospitalization of dementia patients – A descriptive study on a Romanian sample

TUDOSE Catalina, MOGLAN Maria, PAVEL Alexandru Neculai, TIPA Raluca

Romanian Alzheimer Society, Bucharest, Romania

Background: Previous studies have shown contradictory results regarding the hospitalization risk of Alzheimer´s dementia patients.

Methodology: Twenty-nine patients were included from the second ward of the “Alexandru Obregia” Psychiatry Hospital in Bucharest who were admitted between 01.01.2018-31.12.2018. All of them had a discharge diagnosis of dementia (early or late debut Alzheimer´s and mixed).

Results: In 2018, 1217 patients were discharged from our ward and 59 (4.85%) of them had dementia. Most of the patients were male (65.5%) and the mean age was 72 years (SD 9.69). The most frequent diagnosis was dementia with mixed etiology (65.5%), 10 patients scoring over 21 points on the MMSE. Cardiovascular co-morbidities, meaning hypertension or arrythmias, were seen most often (51.34%). The patients diagnosed with dementia had a mean hospitalization cost per day of 132 lei (about 28 euros), compared to non-demented patients, who had 294 lei (62 euros). The mean duration of hospitalization was 9.73 days for non-demented patients similarly with patients diagnosed with dementia (9.31 days). The main admission symptoms of these patients were affective and cognitive (51.7%).

Conclusions: Patients come to the hospital especially when cognitive or affective symptoms emerge, usually noticed by the caregiver. The rather similar hospitalization duration and the administration of a low number of medications points out the limited treatment options for these patients in a psychiatric hospital. The main intervention used is treatment administration. What is more, it is highly likely that most of these symptoms are secondary to a somatic imbalance and that a major psychiatric intervention might not be needed. That being said, the main necessities of these patients are not covered by a hospitalization on a psychiatric ward.

PO1.2. Reacting to mental health crises in dementia: Narrative inquiry and quantum cognition for dyadic coping

BOSCO Alessandro, SCHNEIDER Justine, COLESTON-SHIELDS Donna Maria, ORRELL Martin

University of Nottingham, Nottingham, United Kingdom

Background: Managing crises for people with dementia to help support them at home and avoid hospital admission is a challenging problem, for health and social services. However, little is known about the experiences of people with dementia and their carers around the time of crisis and what could help them cope. This study explores how people with dementia and their carers (i.e. the dyad) manage episodes of crises.

Methods: This was a participatory case study and purposive sampling was used. Participants were recruited from two multidisciplinary teams managing crisis in dementia in the UK. We employed longitudinal dyadic interviews with people with dementia and their family carers over one month. The analysis was performed across cases (thematic analysis) and within cases (narrative inquiry). Grounded theory was used to explain the relationship between themes. Inter-rater reliability was measured through Cohen’s Kappa.

Results: Five dyads were interviewed. Three dyads were husband-wife and two were in daughter-mother relationship. The mean age was 67.4 for carers and 79.8 for people with dementia. Inter-rater reliability was ‘substantial’ (Cohen’s K 0.61-0.80). This study found that the episode of crisis disorients members of the dyad with respect to how effectively manage the situation and when to call for help. During a crisis, the carer becomes the most responsible for managing the episode and s/he is more likely to call for help if the planning is made before the crisis and for the next days as opposed to making the call right when the crisis is experienced.

Discussion: Multidisciplinary teams for crisis prove an important asset in dementia care as they provide professional support to effectively manage critical situations. It is advisable to have only one member of staff who acts as care coordinator for crisis to provide information around behaviour management and care responsibility.

PO1.3. Dementia friendly hospital: A model of care in geriatric ward

FABBO Andrea1, NEVIANI Francesca1, MANZETTO Francesco2, ALFANO Gaia2, RENNA Francesca2, RONTAUROLI Caterina3, BERTOLOTTI Marco2

1Health Authority and Services of Modena, Modena, Italy, 2University of Modena and Reggio Emilia, Modena, Italy, 3Hospital Health Authority and Services of Modena, Modena, Italy

Dementia and delirium are conditions that complicate hospitalization and they involve a high assistance due to the BPSD, with the need of patient protection, prevent of falls and reduce disability (linked to the use of sedative drugs) leading to premature institutionalization. The care requires a multicomponent approach based on psychogeriatric skills, specialized nursing training and use of psychosocial interventions. In our geriatric ward, we promoted a pilot project with aim of realizing a new model of care that reduces length of stay, physical and pharmacological restrains, risk of medical complications and mortality and improves quality of life. We proposed a longitudinal observational pilot case-control study. In the first phase, we organized a staff training (included medical doctors and nurses) on BPSD management and delirium care; in the second phase, we requested in the team the presence of a specialized rehabilitation therapist on multisensory interventions, cognitive stimulation and occupational activities conducted in a special environment (Snoezelen Room).We admitted in the study the elderly people who presented delirium (assessed by 4AT > 4) or BPSD in phase of decompensation (evaluated by NPI score > 24 or at least one single item > 12 ) using a comprehensive geriatric assessment both patient (MMSE, 4AT, MDAS, NPI, CIRS, GDS 15 item, Conley, ADL / IADL, Barthel,Apache) and caregiver ( Zarit and SCQ) admitted into the room.The answer to the care (based on above psychosocial interventions) was monitored daily  (frequency and gravity of behavioral disturbaces, use of psychotropics agents, restrains, falls and length of stay) in the study group  (SG) compared to a control group (CG). 24 cases and 43 controls were recruited for the time being. Our preliminary observations shown that this model of care is feasible and is able to make a difference on quality of care.

PO1.4. Reducing stress and distress in specialist dementia units using evidence-based approaches

LITHGOW Stephen, RODRIGUEZ-CASTELLO Cesar, MCCARTHY Thomas, MILLER Michelle

Healthcare Improvement Scotland, Glasgow, United Kingdom

Introduction: Focus on Dementia, Scotland’s national improvement programme for dementia, has worked with four specialist dementia units (SDU) and developed a national learning and improvement network to support the implementation of commitment 7 of Scotland’s dementia strategy.  

The programme had two components:

(1) Demonstrator Sites:

  • Phase 1 (April 2017-March 2018): the sites used Experience Based Co-design (EBCD) to understand the experiences of people with dementia, their carers and staff to inform the selection of improvement priorities
  • Phase 2 (Apri1 2018-March 2019): improvements were taken forward using the Model for Improvement

(2) Network: Established the SDU Learning and Improvement Network to connect staff in SDUs across Scotland.

The impact of this work. In evaluating this work, we identified seven key impacts:

  • improved understanding of the experiences of people with dementia, carers and staff to inform improvement
  • staff increased quality improvement knowledge and skills and units developed a culture of improvement
  • improved staff resilience as they care for people with dementia
  • improved patient outcomes, e.g. a reduction in stress and distress and reduction in falls
  • process improvements e.g. increasing the use of ABC charts and provision of person centred activity
  • supported the sharing of learning
  • raising the profile of SDUs.

Conclusion: Using a range of creative approaches, it is possible to capture the experiences of people with dementia, carers and staff. The demonstrator sites are now improving clinical practice. This is leading to improvements in the experience for people with dementia, carers and staff.

Next Steps: Based on the learning from the sites and the network, the Focus on Dementia Team are: spreading the learning from this programme via a Dementia in Hospitals Collaborative; sharing learning by launching an online toolkit; publishing evaluation findings.

PO1.5. A diversified approach to promote person with dementia participate shared decision making

LIN Nai-Yu, LIN Su-Mei, LIU Chien-Liang, YU Shu-Min

Taipei City Hospital, Taipei, Taiwan, Province of China

During the course of dementia, 81.4% of patients will have eating and swallowing disorders. 86% of patient will end up with terminal stage dementia. In clinical practice, the tube feeding usually be chosen as a feeding solution, even though it's not the only option.

The shared decision making (SDM) is a process in which clinicians and patients work together to make medical decisions based on evidence-based medicine results. SDM can balance risks and expected outcomes with patient preferences and values. Therefore, it is important to introduce the SDM to the dementia patient who has eating and swallowing problem.

To let dementia families aware of relevant patient decision aids (PDAs) and then participate in shared decision-making, we can apply a diversified approach that allows both family members as well as patient to participate in SDM and to receive necessary information. this diversified approach includes providing lectures, online videos and QR code that about eating and swallowing care, and using social media to send push notifications to dementia family support group.

The number of participants in the lectures was 1,790, the online videos has been shared with 20,872 people. The number of dementia patient who participated in the SDM has reached 40 in a year.

PO1.6. Using the quality control circle method to promote the shared decision making of the person with dementia in the choice of eating option

LIN Nai-Yu, HSU Ya-Chuan, LIU Chien-Liang

Taipei City Hospital, Taipei, Taiwan, Province of China

Shared decision making (SDM) is patient-centered care designed to promote respect and communication. Dementia is a slow progressive disease, with about 81.4% having eating and swallowing disorders. 85.8% of people of end stage dementia have such problems in the past 18 months. In Taiwan, people with dementia have problems of eating and swallowing. They will be taken to the hospital. Doctors usually provide advice on feeding tubes. The recent research shows that nearly one-third of the cases have not been informed of comfortable feeding, except the choice of enteral tube feeding. Therefore, we have form a quality control circle to provide inter-professional practice models. Through this method, the family members and people with dementia can participate shared decision making when eating and swallowing problems, and choose the dietary method that best suits the patient's values and preferences. During the quality control circle, the PDCA (Plan-Execute-Check-Action) method was used to improve the response, and the “Shared decision questionnaire” was designed for SDM quality surveys. A total of 38 people with dementia made joint decisions through family gatherings. After discussion, it was decided to adopt a comfortable feeding of 28 people, a nasogastric tube of 5 people, and 6 people to be discussed again; satisfaction was 97%.

PO1.7. A study on hospitalized person with dementia and their family’s experience of participating in support group

WEI CIH Li

Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan, Province of China

The purpose of this study was to understand the experience of hospitalized person with dementia and their families in support group. This study wants to know about can the courses relieve the pressure of family care?

In this study, qualitative analysis was used to collect research data through semi-structural in-depth interviews to this study. The subjects of the research included five hospitalized persons with dementia’s family members. In this study, the researcher designed the de-stress group courses, and hope to explore the experience and evaluation of patients with dementia and their family members in participating group.

This study found that: (1) The design of courses must be combined with the preferences of participants, so it can initiate their interest and enable participants to enter the curriculum. (2) Regular and continuous participation in the courses will help   them to improve the patients' dementia symptoms, maintain physical function and emotional stability. (3) The family members of the dementia patients could always receive the useful and helpful information from health professionals when they had problems about taking care of the dementia patients. (4) The family members could also discuss problems about disease and care with other caregivers. The support group's companionship enabled the dementia caregivers to have positive feelings. (5) Family members are able to gain a short respite from the patient's participation in this course.

This study suggests that the design of dementia group courses should take into account the characteristics of participants and arrange courses according to their needs.

PO1.8. The influence of regular physiotherapy treatment on the functionality of patients admitted to the unit for gerontopsychiatry at the University Psychiatric Clinic Ljubljana

GOMBOC Marjeta1, GOMBOC Marjeta2

1University Psihiatric Clinic, Ljubljana, Slovenia, 2physiotherapist, counselor, Ljubljana, Slovenia

Introduction: The decline in functional abilities is a common complication when the elderly are admitted to a hospital treatment. The purpose of the study is to determine the impact of regular physiotherapy treatment on maintaining or improving the patient's functional abilities during hospitalization.

Methods: We used a quantitative, retrospective research design. The study included 74 patients of both genders (n = 74). Inclusion criteria: age above 65 years, ability to walk alone and cognitive decline. Measurements are performed with a Mini-Mental State Examination test (MMSE), a 10 m (10 m) walk test and a Timed Up and Go test (TUG). They were performed in group A, patients who had a physiotherapy treatment, and in Group B who did not have one. The first measurement was performed at the patient's admission to the hospital and the second measurement after 3 weeks. The statistical significance of p≤0.05 was taken into account.

Results: In group A, at the second measurement, the timing of the TUG test was shortened on average by 17.9 s (t = 2.67; p = 0.01), TH - 10 m in average by 27.05 s ( t = 4.73, p = 0.00). In group B, at the second measurement, the timing of the TUG test was reduced by 1.84 s (t = 2.19, p = 0.03) and TH - 10 m for 9.44 s (t = 2.84, p = 0.00).

Discussion: Physiotherapy treatment has proven to be a key factor in maintaining or improving the functional status of patients hospitalized due to cognitive impairment. The results of the study confirmed the positive effects of physiotherapy treatment.

Keywords: dementia, functional decline, hospital care

PO1.9. A systematic review of quality indicators for ambulatory dementia care

DEQUANTER Samantha1, BUYL Ronald1, FOBELETS Maaike2

1Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium, 2Erasmus University College Brussels, Department of Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Brussels, Belgium

Purpose: Since dementia prevalence is increasing worldwide and no curative treatment is available, policy emphasis should lay on optimizing the quality of dementia care. To measure and optimize care, quality indicators (QI) can be used. Previous research already identified QIs for this purpose. However, these findings were published more than a decade ago, and to our knowledge, no recent studies on that subject have been conducted. Therefore, we reviewed the most recent literature in the field of QI development for dementia care and made recommendations for future dementia research.

Methods: A systematic review was conducted in three scientific databases: PubMed, CINAHL and The Cochrane Library. Inclusion criteria were: (1) studies focussed on the development or application of QIs for the evaluation of dementia care, from first symptoms until total care support (admission to long-term care), (2) published between 2008 and May 2019. Articles on QIs for residential or inpatient care were excluded.

Results: Seven out of 2344 articles were included. One additional publication was identified through reference tracking. We included a total of 8 QI sets, comprising of 114 QIs. The majority of publications originated from Europe. QIs were generated for outpatient care, primary care and dementia care in general. Most QIs referred to processes of care. Several QI domains were inductively determined, ranging from screening and assessment to end-of-life care. The methodological quality of the QI sets differed considerably. The QI sets with the best methodological quality were developed using expert evaluation or a Delphi technique.

Conclusion: Despite the moderate methodological quality of the QI sets, our findings show that a reasonable amount of QIs representing the most important dementia care domains exists. These QIs can be implemented in practice on the condition that they will be developed further.

 

 
 

Last Updated: Thursday 26 September 2019

 

 
  • Acknowledgements

    The 29th AE Conference in The Hague received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimer Nederlands gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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