Einsatz von sedierenden Medikamenten und bewegungseinschränkenden Maßnahmen bei Patienten mit Demenz im Akutkrankenhaus: Eine nichtrandomisierte Fall-Kontroll-Studie

BACKGROUND: The majority of acute care hospitals are not prepared for people with dementia with acute diseases in need of treatment. This results in an increased likelihood of the personnel being overtaxed. Dementia is the most frequent reason that hospital personnel administer sedating medication and use restraining measures. OBJECTIVE: The aim of this study was to investigate factors that influence the (inappropriate) use of sedating medication and physical restraints for patients with dementia in acute care hospitals. METHODS: A non-randomized case control study, including two internal medicine wards was conducted in Hamburg, Germany. In the intervention group a special care concept was implemented focussing on patients with dementia, while the control group received regular care without a special dementia care concept. Logistic regression models were conducted to investigate associations between factors, such as age, severity of dementia, conspicuous behavior, Barthel index and type of treatment and the use of sedating medication and physical restraint measures. RESULTS: Challenging behavior (odds ratio, OR = 1.32) and treatment in the control group (OR=1.94) were significantly associated with the use of sedating medication. A low Barthel index, longer periods of hospitalization and treatment in the control group were significantly associated with a higher probability of the implementation of physical restraining measures. DISCUSSION: The use of sedating medication as well as physical restraining measures varied greatly between the intervention and control groups. This is in line with other studies that came to similar results and suggests that multiple components of special care concepts can explain these differences. These include architectonic design and spatial aspects as well as dementia-specific training of employees and an appropriate personnel complement. Such interventions can also reduce agitation and behavioral problems of patients. The avoidance of sedation and restraining measures is also positively associated with an increase in the quality of life of patients with dementia.