Objectives To identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients’ QoL.
Design A non-randomised, case–control study including two internal medicine wards from hospitals in Hamburg, Germany.
Setting and participants In all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept.
Outcome measures Our main outcome was the QoL (range 0–100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL.
Results QoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: −4.9), psychotropic drug use (−4.4) and agitation (−2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7).
Conclusions A special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.
- quality of life
- acute hospital
- quality of care
- internal medicine
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Contributors DL was involved in the conception and design of the study, analysis and interpretation of data, and drafting the article. GP was involved in the conception and design of the study and interpretation of data. JK was involved in the interpretation of data and drafting the article. CK was involved in the conception and design of the study, interpretation of data, and drafting the article.
Funding The present study was funded by the Behörde für Gesundheit und Verbraucherschutz (Authority of Health and Consumer Protection) in Hamburg and the Homann Foundation (grant number Z/65454/2014/F500-02.10/10,002). None of the funders was involved in the data analysis process and did not influence or hold back the results of the study.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Prior to the study, a study protocol was developed and submitted to the ethical committee of the medical association of Hamburg ('Ethik-Kommission der Ärztekammer Hamburg'). The IRB of the ethical committee approved the proposal and attested that the study conforms to ethical and legal requirements (approval code PV5102). Study participants were not able to give their informed consent due to their cognitive impairments. However, as data mostly derived from the hospitals’ regular documentation and were completely anonymous, the IRB of the ethics committee waived the need of an informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository.
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