Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study.
BACKGROUND
Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes.


METHODS
The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxon's, McNemar tests, pre-post design).


RESULTS
332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 +/- 8.3 vs. 15.0 +/- 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001).


CONCLUSIONS
The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.
Zieschang
Tania
T
Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany. tzieschang@bethanien-heidelberg.de
Dutzi
Ilona
I
Müller
Elke
E
Hestermann
Ute
U
Grünendahl
Katinka
K
Braun
Anke Karin
AK
Hüger
Daniel
D
Kopf
Daniel
D
Specht-Leible
Norbert
N
Oster
Peter
P
D000208:Acute Disease; D000368:Aged; D003704:Dementia / Q000453:epidemiology*; D004493:Education; D005240:Feasibility Studies; D005260:Female; D006282:Health Personnel / Q000193:education; D006760:Hospitalization; D006801:Humans; D008297:Male; D005791:Patient Care / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D014743:Videotape Recording