Research from UNSW Sydney's Centre for Healthy Brain Ageing (CHeBA) has evaluated the impact of a person-centred intervention on the quality of healthcare and clinical outcomes for people living with dementia, following hospitalisation.
The research, published in the Journal of Alzheimer's Disease, is one of the few studies which have successfully adapted the Kitwood model of person-centred care to the requirements of the sub-acute hospital setting, and to have systematically implemented and rigorously assessed its effectiveness in improving outcomes for people living with dementia.
Professor of Nursing Lynn Chenoweth says that one in four people living with dementia are admitted to hospital in any year, and any of those admissions can be an extremely challenging experience for the individual, as well as their carers.
The multitude of challenges faced include separation anxiety from what is safe and familiar, receiving healthcare from people with little if any knowledge of their life story and unique psychosocial needs, as well as expectations that are often difficult to achieve.
Professor Lynn Chenoweth
The presence of dementia complicates treatment, care, and outcomes for the person and there is a five-fold higher mortality rate for dementia patients during hospitalisation, compared to older adults of the same age without dementia.
"A person with dementia requires specialised care, treatment and support to keep them safe during a hospital stay, which can absolutely occur with person-centred care," says Professor Chenoweth.
Healthcare guidelines promote the Kitwood model of person-centred care in supporting people with dementia who exhibit changed behaviour such as agitation, aggression and refusal of treatment and/or care.
For nine months, 90 sub-acute hospital nursing, allied health and medical staff participated in online or face-to-face person-centred education and were supported in delivering person-centred healthcare by senior nursing, allied health and medical staff champions.
Compared with a group of 78 persons living with dementia not receiving person-centred healthcare, from hospital admission to the week of discharge there was a significant reduction in incidence of delirium and accidents/ injuries, a significant reduction in psychotropic medicines and readmission rates, and an increase in discharge to the person's own home for 80 persons with dementia who received person-centred healthcare. These two participant groups were matched on demographics, cognition and function in activities of daily living. There was also 50% improvement in care quality for persons with dementia following staff education on person-centred healthcare.
We found that implementing the person-centred care model provided significantly improved clinical outcomes for people with dementia; outcomes which are beneficial for the person and their family/carer and represent an enormous cost benefit for health services.
Professor Lynn Chenoweth
67 study participants with dementia and 38 of their family carers reported that they were highly satisfied with the person-centred approach to their healthcare.
The favourable health service and clinical results arising from the study confirm the benefits of providing education and supporting clinical staff in person-centred care practices.
Professor Chenoweth says that future efforts to investigate the therapeutic effects of person-centred care in sub-acute and acute hospital settings should take into consideration the time and financial resources required to plan, implement and evaluate such changes, and to sustain improvements in the outcomes for the person with dementia and the organisation beyond the life of the research project.
