Impact of Patient Centred Care in a Dementia Ward in an Acute Hospital | Stephy publishers

 

Innovative Journal of Neurology and Neuroscience | Stephy Publishers

Abstract
The older persons with dementia will occupy more hospital beds in the years to come. Caring for a patient living with dementia is challenging for the hospital staff, especially for those exhibiting neuropsychiatric symptoms. Providing person centred care has been recognised as the ideal model of care for the persons with dementia. However, this care model is time consuming and requires training and education. Provision of good care in the hospital for the older persons with dementia include avoidance of restraints, prescription of psychotropics, in-hospital fall reduction, minimising risk of cognitive and functional decline with discharge home to their families and loved ones.Person centred care is effective in the acute setting,with proper training, guidance and leadership.

 

Keywords
Dementia, Falls, Restraints, Person-Centred Care, Neuropsychiatric Symptoms

Introduction
Dementia represents a significant health and psychosocial problem in the context of an ageing population.1 The prevalence of dementia and cognitive disorder in Singapore is expected to increase rapidly over the years, as we face the silver tsunami. In high income countries about 50% of the elderly living with dementia is not formally diagnosed. This may be due to lack of public awareness, coupled with lack of confidence among the medical professionals in making a diagnosis. Currently, only 20-50% of cases with dementia are documented in the primary care setting.2 Without formal diagnosis of dementia, the elderly miss out on treatment options, referrals to community services, education, support and counselling for their caregivers. As such, the caregivers often experience caregiver stress leading to burn out as they face increasing difficulties, in terms of symptoms management due to declining cognition, physical burden and emergence of behavioural symptoms. The persons with dementia (PWD) also miss out on opportunities to be included in research. Neuropsychiatric symptoms (NPS) are of primary concern in dementia care. The NPS are difficult to manage, because caregivers stress and increase the risk of institutionalization. The use of psychotropic drugs to control the NPS is known to have harmful side effects, such as falls, extrapyramidal side effects and sedation. Non Pharmacological interventions should be the first approach in managing the NPS, as these are associated with less harm and are more rewarding for the caregivers.

 

The NPS of dementia make little sense to the untrained staff working in an acute hospital with high turnover, except that they frequently cause frustrations and interfere with everyone’s busy work schedule, while worrying about the patients’ safety. These symptoms are often challenging for untrained staff, particularly when they have to balance against patients’ safety when the agitated and restless patients are confused and don’t seem to follow instructions consistently.

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