Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change.
Amanda Leggett, Cathleen Connell, Leslie Dubin and 6 others
PMID 31147289WHAT IT FOUND
Stakeholders reported that dementia care is fragmented, with patients often unrecognized in emergency departments and admitted to psychiatry units for agitation.
Sitters were frequently underused for engagement, and discharge planning was a major bottleneck due to lack of community placement.
Key findings
01Half of patients with dementia seen in the hospital or emergency department had not been seen by the specialized geriatrics clinic in the prior year.
02In the emergency department, dementia is often not identified in the medical record, and patients are described as being passed between medical and psychiatric services due to unclear admission pathways.
03On inpatient units, one-to-one sitters are often used for menial tasks rather than patient engagement, and antipsychotics are overused despite safety warnings.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study was conducted in a single tertiary care system, which may limit generalizability to smaller hospitals or different healthcare models. Demographic data on the interviewees was not collected to maintain confidentiality. The estimates of patient volume were derived from billing data and problem lists, which likely underestimate the true number of people with dementia. The findings reflect stakeholder perceptions and descriptions of care processes rather than objective outcome data or clinical trial results.
Declared interests
No conflicts of interest were reported. The study was supported by the National Institutes of Health and non-U.S. government sources.
The easy way to misread this
Do not interpret the stakeholder recommendations as evidence that specific interventions, such as elder life specialists or web-based training, will improve patient outcomes. This paper reports perceptions of care gaps and does not test any solutions.