Nursing care needs of patients with and without dementia admitted to hospital with fractured neck of femur

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Summary

The aim of this study was to compare people with and without dementia with regards to their levels of functioning prior to fractured neck of femur (NOF), nursing care needs, and length of hospitalisation and discharge destination. Data were extracted from the medical records of 50 patients with fractured NOF and dementia and 50 patients with a fractured NOF who did not have dementia. Patients with dementia were more likely to have been admitted from a residential aged care facility, were more impaired prior to admission, and had more care needs relating to agitation, confusion, eating and drinking, intravenous cannulae, showering and dressing, and incontinence. People with dementia spent two more days in acute care and were less likely to be discharged to a rehabilitation facility. The placement of patients with dementia in dedicated areas of orthopaedic wards, where nurses with specialised skills are able to care for them, and use of practice guidelines are possible solutions to address the current inequity in care.

Introduction

The global prevalence of dementia is predicted to double every 20 years, and by 2040, 81.1 million people will have this condition (Ferri et al., 2005). In Australia, the prevalence of dementia is expected to quadruple during the next 40 years (Access Economics, 2009), and is set to become the largest cause of disability burden by 2016 (Access Economics, 2003). The number of people with dementia as a co-morbidity admitted to acute care hospitals will increase substantially over the coming decades, creating an economic and practice imperative to develop effective and efficient ways of caring for these patients (Olsson et al., 2007, Santamaria et al., 2003). Individuals with dementia are often admitted to acute care hospitals with conditions other than their dementia. Fractured neck of femur (NOF), which occurs more frequently in older people with dementia (Trimpou et al., 2010, Van Doorn et al., 2003), is one such condition. Although it is commonly assumed that the nursing care needs of patients with dementia are higher than other groups of patients admitted to acute care hospitals, there is limited evidence to support this contention (Choong et al., 2000, Courtney et al., 2000, Pearson, 2005). Identifying the nursing care needs of older adults with dementia who are hospitalised with a fractured NOF would provide an evidence base to inform policy makers, health economists, and nursing practice.

In orthopaedic-geriatric units, for example, fractured NOF represent over half of the fractures that clinicians manage (Chong et al., 2008). With the ageing population (Treasury, 2010), there will be a greater demands placed on resources and services. This increase in demand is occurring against a backdrop of continuing decline in bed availability (Choong et al., 2000). Therefore, it is crucial that strategies to enhance the efficiency of health care delivery to patients are underpinned by evidence. Although some clear progress is being made in developing strategies to improve the nursing care and functional outcomes of patients with fractured NOF (Clemow and Seah, 2006, Randall et al., 2008), researchers and clinicians still need to gain a clear understanding of the specific nursing care needs of people with dementia and the type and level of nursing care they require.

In the small cohort of studies on the health outcomes of patients with dementia and a fractured NOF, dementia has been associated with a longer hospital stay, less favourable results of rehabilitation, an increased likelihood of being discharged to a residential aged care facility, increased mortality, and a higher cost per patient compared with patients with a fractured NOF who did not have dementia (Huusko et al., 2000, King et al., 2006, Lyketsos et al., 2000, Shaw and Kenny, 1998). People with dementia admitted to hospital for emergency treatment (such as a fractured NOF) are also more likely to experience a decline in their health, reduced functional independence, and decreased quality of life as a result of the hospital admission (Borbasi et al., 2006, Strachan et al., 2003).

Further understanding of the types of nursing care needs of patients with dementia could inform policy development, hospital funding, and staff allocation. In Australia, the current funding system for acute care hospitals relies on patients’ medical diagnoses to determine the level of subsidy; it is unclear, however, to what extent this system accommodates the nursing care needs of patients with dementia (Duckett and Jackson, 2005). In the absence of this information, it is possible that the care of more complex patients (e.g., those with dementia) may be under-funded, thereby increasing the financial strain of hospitals (Brook, 2008, Duckett and Jackson, 2005).

To enable healthcare resources to be appropriately targeted towards patients with complex nursing care needs, such as those with dementia, it is important to have a clear idea of the type and extent of these needs. The aims of this study were to identify the differences between patients with fractured NOF who had dementia and those who did not have dementia in terms of: (1) levels of functioning prior to fractured NOF; (2) patient care needs (a) upon admission, (b) post-operative, and (c) at discharge; and (3) length of hospitalisation and discharge destination.

Section snippets

Data set

The data for this study came from the medical records of 100 patients who had a primary diagnosis of a fractured NOF, 50 of whom had dementia and 50 of whom did not have this mental health condition.

Design

A retrospective medical record audit was undertaken in an acute health care service.

Audit instrument

An audit tool was developed based on the one used in the O’Connell et al. (2006) study. The audit tool was designed to facilitate the extraction of data from patient medical records, including admission assessment

Description of patients

Of the patients with dementia, 8 were males and 42 were females. Of the patients without dementia, there were 7 males and 43 females. The patients’ ages ranged from 70 to 91 years, with a mean age of 83 years (SD = 5). The mean age of the patients with dementia (M = 83 years, SD = 5) was the same as the mean age of the patients without dementia (M = 83 years, SD = 5). Prior to admission, more people with dementia were living in residential aged care facilities (52%) than people without dementia (8%) and more

Discussion

This study demonstrates that differences between these two groups of patients exist before hospitalisation, with people who have dementia being more dependent on others for basic activities of daily living, such as mobility and transfer, hygiene and toileting, and eating. In addition, significantly more patients with dementia had urinary and faecal incontinence prior to fracturing their NOF. These differences are reflected in the finding that people with dementia were significantly more likely

Conflict of interest statement

There are no conflicts of interest for the authors of this manuscript.

Ethical statement

This study receive ethical approval from clearance from the health service’s and our university’s human research ethics committees. Ethics principles were followed in conducting this study.

Role of funding source

No funding was obtained for this study.

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