Informing policy development regarding the hospital management of people with dementia: A multi-faceted approach

Background
In Australia approximately 30% of older people are from culturally and linguistically diverse (CALD) backgrounds. Hospitals are difficult places for people with dementia and even more difficult for those from CALD backgrounds. 75-90% of patients with dementia experience behavioural and psychological symptoms of dementia (BPSD) during a hospital stay, with agitation and aggression most common1,2. The factors associated with being acutely unwell, combined with unfamiliar environments, heightened by difficulties in communication, can exacerbate BPSD resulting in increased morbidity/mortality and distress. Our aim was to identify the current state regarding BPSD management, compare this with best practice, and inform policy development particularly in relation to those most vulnerable such as people from CALD backgrounds.

Method
Retrospective and prospective observational mixed-methods design in Victorian hospitals. Six studies were conducted: 1) literature review regarding management of patients with dementia; 2) state-wide population-level analysis regarding patients with dementia; 3) inpatient-ward point prevalence of BPSD; 4) hospital-wide audit regarding the severity/impact of dementia; 5) gap analysis regarding models-of-care for patients with dementia; 6) interviews exploring the experiences of staff and family members of patients with dementia.

Result
The synthesised results will be presented. We will outline how these will contribute to a best practice model-of-care for people with dementia in hospital. The challenges in establishing and obtaining relevant data related to dementia, delirium and BPSD in hospitals impacting on evidence-informed policy will also be highlighted.

Conclusion
Policy development for hospital management of people with dementia, particularly minority groups, is a challenge. This is due to the diversity of the population, the diversity in which the condition presents, the speed/severity of disease progression and the multi-component interventions required. It is further complicated by the complexity of hospital systems and difficulties associated with obtaining meaningful and accurate qualitative and quantitative data. Comprehensive and collaborative approaches are urgently needed.

References:

1. Sampson EL, et al. Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital. British J Psych. 2014;205(3):189-96.

2. White N, et al. The management of behavioural and psychological symptoms of dementia in the acute general medical hospital. Int J Geri Psych. 2017;32(3):297-305.