Analysing the management plans for acute dementia patients.
Dementia is a progressive neurological condition that affects memory, thinking, behavior, and the ability to perform everyday activities (Alzheimer’s Association, 2022). The most common type of dementia is Alzheimer’s disease, which accounts for 60-80% of cases (Alzheimer’s Association, 2022). As dementia progresses, patients experience increasing cognitive and functional impairment that often requires long-term care.
The acute care setting, such as the emergency department (ED) or hospital ward, can be disorienting for patients with dementia due to unfamiliar surroundings and staff (Alzheimer’s Society, 2022). Patients may become agitated or aggressive due to confusion, fear, or frustration with their situation. This poses challenges for healthcare providers in safely and effectively assessing, treating, and discharging dementia patients from the acute care setting. Well-developed management plans are needed to optimize outcomes for these vulnerable patients.
This article will analyze components of effective management plans for acute dementia patients, including assessment of decision-making capacity, communication strategies, care approaches, and discharge planning. Relevant literature and guidelines will be reviewed to identify best practices. Real-world examples will demonstrate how these plans can be implemented to improve the acute care experience and outcomes for patients with dementia and their caregivers.
Assessment of Decision-Making Capacity
A key initial step in the management of acute dementia patients is assessing their decision-making capacity regarding treatment and care decisions (American Bar Association, 2016). Capacity refers to a patient’s ability to understand information relevant to their situation and appreciate the potential consequences of decisions. It is task- and time-specific – a patient may be capable of making some decisions but not others, and their capacity may fluctuate over the course of illness and treatment.
Systematic assessment tools can help evaluate a patient’s capacity regarding specific medical interventions or discharge plans (Grisso et al., 1997). For example, the University of California Brief Assessment of Capacity (UBAC) examines a patient’s understanding of their condition, treatment options, risks/benefits of treatment, and ability to reason and deliberate (Jeste et al., 2007). Scores on validated tools provide an objective measure of capacity that can guide care decisions and planning.
If a patient lacks capacity, a substitute decision-maker identified in an advance care plan or designated by the state/province assumes responsibility for consenting to treatment on their behalf (American Bar Association, 2016). Even without formal capacity, involving patients in decisions to the extent possible respects their autonomy and dignity.
Communication Strategies
Effective communication is paramount when interacting with acute dementia patients, who may have impaired comprehension, expression, and memory due to cognitive changes (Alzheimer’s Society, 2022). Caregivers should introduce themselves by name, maintain eye contact, speak slowly and clearly in short sentences using simple vocabulary, and give the patient time to process and respond to questions.
It can also help to validate the patient’s feelings, reorient them to time/place frequently, and provide cues or reminders if they seem confused or distracted (Alzheimer’s Society, 2022). Familiar people and objects from home, such as family photos, can make an unfamiliar setting feel more comfortable and predictable. Ensuring patients have glasses or hearing aids as needed supports comprehension.
Consistent communication strategies across care teams optimize understanding for patients during transitions between departments and providers. At discharge, clear, written instructions in large print reinforce the plan of care for patients and caregivers to reference later (Alzheimer’s Society, 2022). These approaches facilitate assessment, treatment adherence, and safe transitions for individuals with impaired cognition.
Care Approaches
Several care approaches have been shown to reduce agitation, aggression and distress in acute dementia patients compared to traditional medical management alone. Integrated care models incorporating nonpharmacological interventions yield better outcomes.
Person-centered care focuses on understanding each individual’s unique background, preferences, and needs to guide care in a way that maintains dignity and quality of life (Brooker, 2007). This may involve engaging familiar activities, personalized comfort measures, and distraction from anxiety-provoking procedures.
Other strategies like simulated presence therapy using personalized family photos or familiar objects can calm and orient patients (Moyle et al., 2018). Gentle exercise, music therapy, and outdoor garden access have decreased agitation and improved mood in hospitalized dementia patients (Vink et al., 2003; Raglio et al., 2015).
Multicomponent programs combining behavioral management techniques, staff education, and a calming physical environment demonstrate the greatest benefit (Chenoweth et al., 2009). Nonpharmacological approaches should be tried before medications when possible due to side effects in older adults. A multidisciplinary team supports comprehensive, individualized care.
Discharge Planning
Early, collaborative discharge planning is critical for acute dementia patients to support safe transitions home or to subsequent care settings. Potential delays or barriers to discharge due to cognitive or functional issues require proactive problem-solving.
Standardized tools like the Hospital Elder Life Program Confusion Assessment Method identify delirium risk factors to address before discharge (Inouye et al., 1990). Caregivers are educated on the patient’s condition, medications, and self-care needs. Community referrals are arranged for ongoing support services as indicated.
Discharge locations should be assessed for safety, with modifications like grab bars or motion sensor as indicated.
Discharge locations should be assessed for safety, with modifications like grab bars or motion sensor lights if needed. A transitional care program involving post-discharge home visits or telephone check-ins by an advanced practice nurse decreased rehospitalizations in one study (Naylor et al., 2004). Comprehensive discharge planning optimizes outcomes for vulnerable dementia patients.
Conclusion
In summary, well-developed management plans are essential to meet the complex needs of acute dementia patients. Key elements include validated assessment of decision-making capacity, communication strategies tailored to cognitive impairment, individualized nonpharmacological care approaches, and proactive discharge planning involving caregivers. An integrated, multidisciplinary team approach applying these best practices can significantly improve experiences and outcomes for patients with dementia receiving acute medical care. With an aging population, further research optimizing care models will continue to advance quality of life for these vulnerable individuals and their families.
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