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Person-centered care for older people with dementia in the acute hospital

INTRODUCTION: Patients with dementia (PWDs) are often subjected to enforced dependency and experience functional decline and emotional distress during hospital stay. Person-centered care (PCC) with specialized psychosocial interventions, minimally obtrusive medical care, and physical restraints-free...

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Autores principales: Tay, Felicia Hui En, Thompson, Claire L., Nieh, Chih Ming, Nieh, Chih Chiang, Koh, Hui Mien, Tan, Jessie Joon Cheen, Yap, Philip Lin Kiat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021231/
https://www.ncbi.nlm.nih.gov/pubmed/29955648
http://dx.doi.org/10.1016/j.trci.2017.11.003
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author Tay, Felicia Hui En
Thompson, Claire L.
Nieh, Chih Ming
Nieh, Chih Chiang
Koh, Hui Mien
Tan, Jessie Joon Cheen
Yap, Philip Lin Kiat
author_facet Tay, Felicia Hui En
Thompson, Claire L.
Nieh, Chih Ming
Nieh, Chih Chiang
Koh, Hui Mien
Tan, Jessie Joon Cheen
Yap, Philip Lin Kiat
author_sort Tay, Felicia Hui En
collection PubMed
description INTRODUCTION: Patients with dementia (PWDs) are often subjected to enforced dependency and experience functional decline and emotional distress during hospital stay. Person-centered care (PCC) with specialized psychosocial interventions, minimally obtrusive medical care, and physical restraints-free practice holds potential to improve patient outcomes. We evaluate the effectiveness of an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]) that adopts a PCC protocol. METHODS: Prospective naturalistic cohort study whereby PWDs in the CAMIE unit (n = 170) were compared with a control group in usual care wards (n = 60) over 6 months. Assessments included patient demographics, dementia type and stage, comorbidities (Charlson's Comorbidity Index), acute illness severity, Well-Being, Ill-Being, functional status (Modified Barthel Index), agitation levels (Pittsburgh Agitation Scale), and quality of life (EuroQoL), assessed on admission and discharge. Multivariate analysis of covariance examined the effect of CAMIE versus usual care on pre-post outcomes. RESULTS: CAMIE patients showed statistically significant greater gains in Modified Barthel Index function and Well-Being, decreased Ill-Being and agitation, and greater improvement in EuroQoL index score (effect size: Δ = 0.18) after adjusting for baseline differences that translated to a quality-adjusted life years gain of 0.045, assuming stability over 3 months. Estimating added cost of CAMIE stay over usual care at SGD 1500 (USD 1040) for average length of stay of 15 days per patient, the incremental cost-effectiveness ratio fell within the threshold for cost-effectiveness at USD 23,111. DISCUSSION: PCC for PWDs in acute hospitals not only improves clinical outcomes for patients but is also cost-effective. The results support the adoption of PCC on a wider scale for better care of PWDs.
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spelling pubmed-60212312018-06-28 Person-centered care for older people with dementia in the acute hospital Tay, Felicia Hui En Thompson, Claire L. Nieh, Chih Ming Nieh, Chih Chiang Koh, Hui Mien Tan, Jessie Joon Cheen Yap, Philip Lin Kiat Alzheimers Dement (N Y) Featured Article INTRODUCTION: Patients with dementia (PWDs) are often subjected to enforced dependency and experience functional decline and emotional distress during hospital stay. Person-centered care (PCC) with specialized psychosocial interventions, minimally obtrusive medical care, and physical restraints-free practice holds potential to improve patient outcomes. We evaluate the effectiveness of an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]) that adopts a PCC protocol. METHODS: Prospective naturalistic cohort study whereby PWDs in the CAMIE unit (n = 170) were compared with a control group in usual care wards (n = 60) over 6 months. Assessments included patient demographics, dementia type and stage, comorbidities (Charlson's Comorbidity Index), acute illness severity, Well-Being, Ill-Being, functional status (Modified Barthel Index), agitation levels (Pittsburgh Agitation Scale), and quality of life (EuroQoL), assessed on admission and discharge. Multivariate analysis of covariance examined the effect of CAMIE versus usual care on pre-post outcomes. RESULTS: CAMIE patients showed statistically significant greater gains in Modified Barthel Index function and Well-Being, decreased Ill-Being and agitation, and greater improvement in EuroQoL index score (effect size: Δ = 0.18) after adjusting for baseline differences that translated to a quality-adjusted life years gain of 0.045, assuming stability over 3 months. Estimating added cost of CAMIE stay over usual care at SGD 1500 (USD 1040) for average length of stay of 15 days per patient, the incremental cost-effectiveness ratio fell within the threshold for cost-effectiveness at USD 23,111. DISCUSSION: PCC for PWDs in acute hospitals not only improves clinical outcomes for patients but is also cost-effective. The results support the adoption of PCC on a wider scale for better care of PWDs. Elsevier 2017-12-06 /pmc/articles/PMC6021231/ /pubmed/29955648 http://dx.doi.org/10.1016/j.trci.2017.11.003 Text en © 2017 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Featured Article
Tay, Felicia Hui En
Thompson, Claire L.
Nieh, Chih Ming
Nieh, Chih Chiang
Koh, Hui Mien
Tan, Jessie Joon Cheen
Yap, Philip Lin Kiat
Person-centered care for older people with dementia in the acute hospital
title Person-centered care for older people with dementia in the acute hospital
title_full Person-centered care for older people with dementia in the acute hospital
title_fullStr Person-centered care for older people with dementia in the acute hospital
title_full_unstemmed Person-centered care for older people with dementia in the acute hospital
title_short Person-centered care for older people with dementia in the acute hospital
title_sort person-centered care for older people with dementia in the acute hospital
topic Featured Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021231/
https://www.ncbi.nlm.nih.gov/pubmed/29955648
http://dx.doi.org/10.1016/j.trci.2017.11.003
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