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Specialist medical and mental health unit for older people with cognitive impairment
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Objective: To develop and evaluate a best practice model of general hospital acute medical care for older people with cognitive impairment.
Design: Randomised controlled trial, adapted to take account of constraints imposed by a busy acute medical admission system in a large acute general hospital in the United Kingdom.
Participants: 600 patients aged over 65 admitted for acute medical care, identified as "confused" on admission.
Interventions: Participants were randomised to a specialist medical and mental health unit, designed to deliver best practice care for people with delirium or dementia, or to standard care (acute geriatric or general medical wards). Features of the specialist unit included joint staffing by medical and mental health professionals; enhanced staff training in delirium, dementia, and person centred dementia care; provision of organised purposeful activity; environmental modification to meet the needs of those with cognitive impairment; delirium prevention; and a proactive and inclusive approach to family carers.
Main outcome measures Primary outcome: number of days spent at home over the 90 days after randomisation. Secondary outcomes: structured non-participant observations to ascertain patients' experiences; satisfaction of family carers with hospital care. When possible, outcome assessment was blind to allocation.
Conclusions Specialist care for people with delirium and dementia improved the experience of patients and satisfaction of carers, but there were no convincing benefits in health status or service use. Patients' experience and carers' satisfaction might be more appropriate measures of success for frail older people approaching the end of life.
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