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

journal contribution
posted on 31.05.2019, 00:00 by FHE Tay, Claire Thompson, CM Nieh, CC Nieh, HM Koh, JJC Tan, PLK Yap
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. © 2017 The Authors

History

Volume

4

Start Page

19

End Page

27

Number of Pages

9

eISSN

2352-8737

ISSN

2352-8737

Publisher

Elsevier

Additional Rights

CC BY NC ND 4.0

Peer Reviewed

Yes

Open Access

Yes

External Author Affiliations

Geriatric Education and Research Institute, National University of Singapore Yong Loo Lin School of Medicine, Khoo Teck Puat Hospital, Khoo Teck Puat-National University Children’s Medical Institute, Singapore

Era Eligible

Yes

Journal

Alzheimer's and Dementia: Translational Research and Clinical Interventions

Exports

CQUniversity

Exports