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. 2017 Dec 6:4:19-27.
doi: 10.1016/j.trci.2017.11.003. eCollection 2018.

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

Felicia Hui En Tay  1   2 , Claire L Thompson  3   4 , Chih Ming Nieh  5 , Chih Chiang Nieh  6 , Hui Mien Koh  5 , Jessie Joon Cheen Tan  5 , Philip Lin Kiat Yap  5   7
Affiliations

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

Felicia Hui En Tay et al. Alzheimers Dement (N Y). .

Abstract

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.

Keywords: Acute hospital; Cost-effectiveness; Dementia; Geriatric; Person-centered care.

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Figures

Fig. 1
Fig. 1
Pre-post mean WB scores for both groups. Abbreviations: CAMIE, Care for Acute Mentally Infirm Elders; WB, Well-Being.
Fig. 2
Fig. 2
Pre-post mean IB scores for both groups. Abbreviations: CAMIE, Care for Acute Mentally Infirm Elders; IB, Ill-Being.
Fig. 3
Fig. 3
Pre-post mean PAS scores for both groups. Abbreviations: CAMIE, Care for Acute Mentally Infirm Elders; PAS, Pittsburg Agitation Scale.
Fig. 4
Fig. 4
Pre-post mean MBI scores for both groups. Abbreviations: CAMIE, Care for Acute Mentally Infirm Elders; MBI, Modified Barthel Index.
Fig. 5
Fig. 5
Pre-post mean EQ-5D index scores for both groups. Abbreviations: CAMIE, Care for Acute Mentally Infirm Elders; EQ-5D, EuroQoL.
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