Persons with Alzheimer?s Disease and Related Dementias (ADRD) currently account for 3.2 million hospital admissions per year and have over three times more hospitalizations than those without cognitive impairment. Yet, hospital caregivers are currently ill-prepared to manage patients with ADRD, with less than 5% reporting mandatory dementia care training. Three-quarters of hospitalized persons with ADRD display Behavioral and Psychological Symptoms of Dementia (BPSD), associated with functional and cognitive decline, increased resource consumption, institutionalization, premature death, and caregiver burden. The overall objective of this project is to test the preliminary efficacy of an innovative model of care, the PES-4-BPSD, for reducing BPSD by empowering Patient Engagement Specialist (PES) to deliver dementia care for acutely-ill patients with ADRD. Traditionally, mental health assistants with training in crisis-prevention techniques provide care to psychiatric patients. On the intervention unit, these mental health assistants, as PES, purposefully engage patients with BPSD. In our pilot study, we found that patients with cognitive impairment admitted to the PES unit were significantly less likely to require constant observation, chemical and physical restraints, suggesting improved management of BPSD. Our central hypothesis is that the PES-4-BPSD intervention will improve the ability of PES to create an ?enabling? milieu that addresses the factors leading to BPSD and improves the experience of hospital caregivers. Guided by a social-ecological framework, the PES-4-BPSD model incorporates: dementia education and training, environmental modifications-cohorting, increased staffing-PES, and staff support. Our multidisciplinary research team is well-positioned to accomplish the following aims:
Aim 1 : Determine the preliminary efficacy of the PES-4-BPSD intervention for reducing BPSD during hospitalization and Aim 2: Evaluate whether dementia care training improves the perceived ability of PES staff (intervention) and nurse assistant staff (control) to care for hospitalized persons with ADRD.
For Aim 1, we will conduct a non-randomized preliminary efficacy trial of the PES-4-BPSD intervention enrolling N=158 patients (79 control and 79 intervention). The primary outcome will be the presence (through a multi-modal approach) of BPSD during hospitalization using the Neuropsychiatric Inventory-Questionnaire (NPI-Q).
In Aim 2, we will use survey methodology in a repeated measures design to evaluate within and between-group differences in attitudes, experience, and satisfaction toward managing patients with ADRD. Measures will be completed at baseline (T1), immediately following training (T2), and at end of the intervention period (T3). In response to the 2017 NIA Workshop, ?Innovating the Next Generation of Dementia and Alzheimer's Disease Care Interventions?, this proposal will be the first to study an innovative model of care utilizing PES as specialized hospital caregivers for reducing BPSD in the hospital setting. Our findings will lay the essential groundwork for a multi-site trial of PES-4-BPSD, and will inform the development of a program that can be easily implemented in other hospitals.
This study will test the preliminary efficacy of an innovative model of care, the PES-4-BPSD, to reduce behavioral and psychological symptoms of dementia (BPSD) in hospitalized patients with Alzheimer?s Disease and Related Dementias (ADRD) via Patient Engagement Specialists (PES). The components of the PES-4- BPSD address the factors that predispose hospitalized patients with ADRD to develop BPSD, namely: dementia education and training, environmental modifications, increased staff ratio for non-medical needs with PES, and providing staff support to improve staff attitude and empathy. With the unprecedented number of hospitalized persons with dementia, the PES-4-BPSD model offers a practical and effective way to optimize hospital care for persons with dementia and improve the experience of hospital caregivers in providing dementia care.
