Review Article
Supporting dementia patients in hospital environments: health-related risks, needs and dedicated structures for patient care
D. M. Hermann,
S. Muck,
H.-G. Nehen,
Corresponding Author
D. M. Hermann
Department of Neurology, University Hospital Essen, Essen, Germany
Correspondence: D. M. Hermann, Chair of Vascular Neurology and Dementia, Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany (tel.: +49 201 723 2814; fax: +49 201 723 5534; e-mail: [email protected]).Search for more papers by this authorS. Muck
Department of Geriatrics, Elisabeth Hospital Essen, Essen, Germany
Search for more papers by this authorH.-G. Nehen
Department of Geriatrics, Elisabeth Hospital Essen, Essen, Germany
Search for more papers by this authorD. M. Hermann,
S. Muck,
H.-G. Nehen,
Corresponding Author
D. M. Hermann
Department of Neurology, University Hospital Essen, Essen, Germany
Correspondence: D. M. Hermann, Chair of Vascular Neurology and Dementia, Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany (tel.: +49 201 723 2814; fax: +49 201 723 5534; e-mail: [email protected]).Search for more papers by this authorS. Muck
Department of Geriatrics, Elisabeth Hospital Essen, Essen, Germany
Search for more papers by this authorH.-G. Nehen
Department of Geriatrics, Elisabeth Hospital Essen, Essen, Germany
Search for more papers by this authorAbstract
The diagnostics and treatment of dementia are progressively gaining importance for European neurologists. Our hospital structures are poorly prepared for patients suffering from dementia. As a consequence of cognitive and physical deficits, dementia patients have an increased risk for serious complications and poor outcomes in hospital environments. In this review, the specific needs of dementia patients are outlined, describing how geriatricians, neurologists and psychiatrists may contribute to better patient care, e.g. with consultation or liaison services, geriatric wards, dedicated dementia wards or memory clinics in interaction with nurses, occupational therapists, physiotherapists, speech therapists, psychologists and social workers. Due to their multifaceted needs, dementia patients can most successfully be supported in clinical environments that closely integrate specialized inpatient, outpatient and primary care offers.
References
- 1Ferri CP, Prince M, Brayne C, et al.; Alzheimer's Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366: 2112–2117.
- 2 World Health Organization. Priority Medicines for Europe and the World − Update Report. Chapter 6.11: Alzheimer's disease and other dementias. World Health Organization, 2013. Internet: http://www.who.int/medicines/areas/priority_medicines/Ch6_11Alzheimer.pdf (accessed 03/03/2014).
- 3 Alzheimer Europe. Prevalence of dementia in Europe. Alzheimer Europe Luxemburg, 2009. Internet: http://www.alzheimer-europe.org/Research/European-Collaboration-on-Dementia/Prevalence-of-dementia (accessed 03/03/2014).
- 4Bickel H. Stand der Epidemiologie. In: F Hallauer, A Kurz, eds. Weißbuch Demenz − Versorgungssituation relevanter Demenzerkrankungen in Deutschland. Stuttgart: Thieme, 2002: 10–14.
- 5Bickel H. Das Wichtigste: Die Epidemiologie der Demenz. Deutsche Alzheimer-Gesellschaft e.V., 2010. Internet: http://www.deutsche-alzheimer.de/fileadmin/alz/pdf/factsheets/FactSheet01_2012_01.pdf (accessed 03/03/2014).
- 6Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA 2012; 307: 165–172.
- 7Grober E, Sanders A, Hall CB, Ehrlich AR, Lipton RB. Very mild dementia and medical comorbidity independently predict health care use in the elderly. J Prim Care Community Health 2012; 3: 23–28.
- 8Sampson EL, Blanchard MR, Jones L, Tookman A, King M. Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 2009; 195: 61–66.
- 9Toot S, Devine M, Akporobaro A, Orrell M. Causes of hospital admission for people with dementia: a systematic review and meta-analysis. J Am Med Dir Assoc 2013; 14: 463–470.
- 10Erkinjuntti T, Wikström J, Palo J, Autio L. Dementia among medical inpatients. Evaluation of 2000 consecutive admissions. Arch Intern Med 1986; 146: 1923–1926.
- 11Kolbeinsson H, Jónsson A. Delirium and dementia in acute medical admissions of elderly patients in Iceland. Acta Psychiatr Scand 1993; 87: 123–127.
- 12Kleina T, Wingenfeld K. Die Versorgung demenzkranker älterer Menschen im Krankenhaus. Veröffentlichungsreihe des Instituts für Pflegewissenschaft an der Universität Bielefeld. Bielefeld: Institut für Pflegewissenschaft an der Universität Bielefeld, 2007: 1–88. ISSN-1435-408X.
- 13Mukadam N, Sampson EL. A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. Int Psychogeriatr 2011; 23: 344–355.
- 14Lyketsos CG, Sheppard JM, Rabins PV. Dementia in elderly persons in a general hospital. Am J Psychiatry 2000; 157: 704–707.
- 15Zekry D, Herrmann FR, Grandjean R, et al. Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients. Int J Geriatr Psychiatry 2009; 24: 283–291.
- 16Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340: 669–676.
- 17Reischies FM, Diefenbacher A. Delirium in general hospital inpatients: German developments. Adv Psychosom Med 2004; 26: 128–136.
- 18Sourial R, McCusker J, Cole M, Abrahamowicz M. Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. Int Psychogeriatr 2001; 13: 183–197.
- 19Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing 2009; 38: 19–26.
- 20Härlein J, Dassen T, Halfens RJ, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs 2009; 65: 922–933.
- 21Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 2012; 41: 299–308.
- 22Gleason CE, Gangnon RE, Fischer BL, Mahoney JE. Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial. Dement Geriatr Cogn Disord 2009; 27: 557–563.
- 23Baldwin R, Pratt H, Goring H, Marriott A, Roberts C. Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial Age Ageing 2004; 33: 472–478.
- 24Ellis G, Whitehead MA, Robinson D, O'Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011; 343: d6553.
- 25George J, Adamson J, Woodford H. Joint geriatric and psychiatric wards: a review of the literature. Age Ageing 2011; 40: 543–548.
- 26Slaets JPJ, Kauffmann RH, Duivenvoorden HJ, Pelemans W, Schudel WJ. A randomised trial of geriatric liaison intervention in elderly medical inpatients. Psychosom Med 1997; 59: 585–591.
- 27Maier AB, Wachtler C, Hofmann W. Combined medical-psychiatric inpatient units. Z Gerontol Geriatr 2007; 40: 268–274.
- 28Wong TNDM, Geddes JAA, Inderjeeth CA. Innovations in aged care. Delirium unit: our experience. Aus J Ageing 2009; 28: 206–210.
- 29Chiu A, Nguyen HV, Reutens S, et al. Clinical outcomes and length of stay of a co-located psychogeriatric and geriatric unit. Arch Gerontol Geriatr 2009; 49: 233–236.
- 30Pitt B, Silver CP. The combined approach to geriatrics and psychiatry. Evaluation of a joint unit in a teaching hospital district. Age Ageing 1980; 9: 33–37.
- 31George J, Bleasdale S. Managing delirium in elderly people. Elderly Care 1996; 8: 13–14.
- 32Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–1036.
- 33Dobrohotoff JT, Llewellyn-Jones RH. Psychogeriatric inpatient unit design: a literature review. Int Psychogeriatr 2011; 23: 174–189.
- 34Ho V, Nicholl CG. Dementia care on medical and medicine for the elderly wards. Psychiatr Danub 2013; 25: S272–S277.
- 35Rösler A, Hofmann W, von Renteln-Kruse W, et al. Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany. Z Gerontol Geriatr 2010; 43: 249–253.
- 36Hofmann W, Rösler A, Vogel W, Nehen HG; For the Deutsche Gesellschaft für Geriatrie (DGG), with involvement of Bundesverband der Geriatrie (BVG). Consensus for special care units of acutely ill patients with cognitive impairment in Germany. Zeitschr Gerontol Geriatr 2014; 47: 136–140.
- 37Goldberg SE, Bradshaw LE, Kearney FC, et al.; Medical Crises in Older People Study Group. 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 2013; 347: f4132.
- 38Jolley D, Benbow SM, Grizzell M. Memory clinics. Postgrad Med J 2006; 82: 199–206.
- 39Meeuwsen EJ, Melis RJ, Van Der Aa GC, et al. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial. BMJ 2012; 344: e3086.
- 40Nehen H-G, Hermann DM. Supporting dementia patients and their caregivers in daily life challenges: review of physical, cognitive and psychosocial intervention studies. Eur J Neurol 2014; doi:10.1111/ene.12535 [Epub ahead of print].
- 41George J, Long S, Vincent C. How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. J R Soc Med 2013; 106: 355–361.
- 42Griffiths A, Knight A, Harwood R, Gladman JR. Preparation to care for confused older patients in general hospitals: a study of UK health professionals. Age Ageing 2014; 43: 521–527.
- 43 World Health Organization. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. World Health Organization, 2012. Internet: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_R8-en.pdf (accessed 03/03/2014).
- 44Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol 2011; 7: 323–331.
