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QUALIDEM subdomain scores by care ward in patients with very severe dementia (Mini-Mental State Examination Test score <7, n=126).
Source publication
Objectives To identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients’ QoL.
Design A non-randomised, case–control study including two internal medicine wards from hospitals in Hamburg, Germany.
Setting and participants In all, 526 patients...
Context in source publication
Context 1
... same consistent pattern can be found for patients with very severe dementia symptoms (MMSE score <7). Here, only the second of the six applied subdomains ('positive affect') does not differ significantly between the intervention and the control group ( figure 2). Figure 3 shows the results from the Bayesian mixed model. ...
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Citations
... Meanwhile, dementia severity was also associated with worse HRQoL in patients with the majority of severe dementia. 5. (Lüdecke et al., 2019). ...
... Honarvar et al., 2020);(Klapwijk et al., 2016);(Henskens et al., 2019);(Garre-Olmo et al., 2017).Comorbidity(Klapwijk et al., 2016);(Salminen et al., 2019);(Appelhof et al., 2017);.Severe Dementia(Lüdecke et al., 2019).Physical Restraint(Klapwijk et al., 2016);(Garre-Olmo et al., 2017).ADL capabilities(Honarvar et al., 2020);(Ibsen et al., 2019).Physical Activity(Garre-Olmo et al., 2017). Cognitive Status (van de Rijt et al., 2021). ...
... Primary data was collected in a study called "DAVID" (German acronym for Diagnostics, Acute therapy, Validation at an Internal medicine ward for patients with Dementia) that compared the quality of care for patients with dementia within an internal medicine unit with a specialised dementia care concept as opposed to regular care in acute hospitals. The study was designed as a cross-sectional case-controlstudy, including two internal medicine wards in two hospitals located in Hamburg, Germany [15]. ...
Background
Quality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD’s QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not demonstrated their feasibility in acute hospitals. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed.
Methods
Data stem from a study that analysed the impact of a special care concept in acute hospitals for patients with dementia on their QoL. Total sample size consisted of N = 526 patients. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis.
Results
For people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two (positive self-image, feeling at home) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65 to 0.91). Only the item social relations had insufficient reliability (ρ = 0.55).
Conclusions
In comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is recommended.
The purpose of this study was to review nursing management literature on reducing physical restraint in acute hospitals and clarify recent trends and issues in the future. The databases, which were searched on January 5, 2020, include; PubMed, CINAHL with Full Text, the Cochrane library, and Japan Medical Abstracts Society. A total of 190 studies were identified in the search, although only 15 studies (seven in Japanese and eight in English), published between 2000 and 2019, that met the inclusion criteria were selected. Intention of nursing management practice under factors of physical restraint included ethics, older people, falls, delirium, quality of cure and care, short of manpower, dementia. The main contents of nursing management practice were: 1) setting goals and judge criteria; 2) clarification of issues; 3) sharing problem recognition; 4) reviewing and constructing system; 5) security assurance; 6) providing educational opportunities; 7) launching and operating teams; 8) promoting cooperation; 9) motivation; and, 10) evaluating trial. The non-randomized controlled trial was found to reduce time and the rate of physical restraint while improving knowledge and attitude. Future studies need to indicate common nursing management evaluation items or indicator to consider reducing physical restraint for any acute hospital in spite of difference in hospital size.
Background
Quality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD’s QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not yet demonstrated their feasibility in acute hospitals because their use takes up too much time or their validity depends on observation periods that usually exceed the average length of hospital stays. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed.
Methods
Data stem from a study that analyzed the impact of a special care concept on the QoL of patients with dementia in acute hospitals. Total sample size consisted of N = 526 patients. Study nurses were trained in using an assessment questionnaire and conducted the data collection from June 2016 to July 2017. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis.
Results
For people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two ( positive self-image , feeling at home ) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65–0.91). Only the item s ocial relations had insufficient reliability (ρ = 0.55).
Conclusions
In comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is necessary because the qualification of the nurses and the length of stay of the patients in the hospital differ from the previous investigations of the inter-rater reliability of QUALIDEM in the nursing home.
Introduction
People with dementia may refuse care because they feel overwhelmed by an unfamiliar environment. Everyday technology such as tablets have the potential to support person-centred dementia care in hospitals.
Aims
We aimed to identify barriers and enabling factors in order to develop a toolkit to support the use of tablets in engaging individual and group activities, especially to play family videos, for hospitalized older people with dementia.
Methods
A participatory action research approach was employed. We facilitated staff focus groups and conducted interviews with stakeholders. A toolkit was developed based on participants’ perspectives on how to support successful adoption.
Results
Our analysis identified two enabling factors: users’ engagement in developing a toolkit for support and adapting implementation to meet local needs. Barriers included staff and family inexperience, mechanical instability of hardware, issues around privacy and data access, technology use and personalization of messages. The toolkit includes short videos, a brochure for family caregivers, and a pocket card for staff. Discussion and implications: Staff, family and patients start with varying levels of experience with the use of tablets, making education and support vitally important to implementation. Health organizations should involve staff, patients, and families to find practical solutions.
