a1 Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
a2 Klinikum Ludwigsburg, Ludwigsburg, Germany
a3 Medical Hospital, University of Heidelberg, Germany
Background: Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes.
Methods: The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxon's, McNemar tests, pre-post design).
Results: 332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 ± 8.3 vs. 15.0 ± 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001).
Conclusions: The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.
(Received January 15 2009)
(Revised February 22 2009)
(Revised May 19 2009)
(Accepted May 20 2009)
(Online publication July 15 2009)
c1 Correspondence should be addressed to: Dr. Tania Zieschang, MD, Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Rohrbacher Strasse 149, 69126 Heidelberg, Germany. Phone: +49-6221-3191746; Fax: +49-6221-3191505. Email: firstname.lastname@example.org.