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Dementia-friendly Hospitals: Care not Crisis: An Educational Program Designed to Improve the Care of the Hospitalized Patient With Dementia

Galvin, James E. MD, MPH*,†,‡,§; Kuntemeier, Barbara MA, MS*; Al-Hammadi, Noor MBChB, MPH*; Germino, Jessica BA*; Murphy-White, Maggie MA; McGillick, Janis MSW

Alzheimer Disease & Associated Disorders:
doi: 10.1097/WAD.0b013e3181e9f829
Original Articles
Abstract

Background: Approximately 3.2 million hospital stays annually involve a person with dementia, leading to higher costs, longer lengths of stay, and poorer outcomes. Older adults with dementia are vulnerable when hospitals are unable to meet their special needs.

Methods: We developed, implemented, and evaluated a training program for 540 individuals at 4 community hospitals. Pretest, posttest, and a 120-day delayed posttest were performed to assess knowledge, confidence, and practice parameters.

Results: The mean age of the sample was 46 years; 83% were White, 90% were female, and 60% were nurses. Upon completion, there were significant gains (P's <0.001) in knowledge and confidence in recognizing, assessing, and managing dementia. Attendees reported gains in communication skills and strategies to improve the hospital environment, patient safety, and behavioral management. At 120 days, 3 of 4 hospitals demonstrated maintenance of confidence. In the hospital that demonstrated lower knowledge and confidence scores, the sample was older and had more nurses and more years in practice.

Conclusions: We demonstrate the feasibility of training hospital staff about dementia and its impact on patient outcomes. At baseline, there was low knowledge and confidence in the ability to care for dementia patients. Training had an immediate impact on knowledge, confidence, and attitudes with lasting impact in 3 of 4 hospitals. We identified targets for intervention and the need for ongoing training and administrative reinforcement to sustain behavioral change. Community resources, such as local chapters of the Alzheimer Association, may be key community partners in improving care outcomes for hospitalized persons with dementia.

Author Information

*Alzheimer Disease Research Center

Departments of Neurology

Psychiatry

§Neurobiology, Washington University School of Medicine

Alzheimer Association, St Louis Chapter, St Louis, MO

Supported by grants from the National Institutes of Health P50 AG05681, the Retirement Research Foundation, and the Alzheimer Association.

James E. Galvin is now located at New York University Langone School of Medicine.

Statistical Analysis was conducted by Noor Al-Hammadi, MBChB, MPH and James E. Galvin, MD, MPH, Washington University School of Medicine.

Reprints: James E. Galvin, MD, MPH, Center of Excellence on Brain Aging, New York University Langone School of Medicine, 145 East 32nd Street, 2nd Floor, New York, NY 10016 (e-mail: James.Galvin@nyumc.org).

Received November 18, 2009

Accepted May 6, 2010

© 2010 Lippincott Williams & Wilkins, Inc.