Research Abstract: Free Paper - Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

An Acute Cognition Unit provides effective treatment for clinically significant changed behaviours and psychological symptoms in hospitalised patients with dementia. (#70)

Frederick A Graham 1 2 , Emily Gordon 1 2 , Ruth E Hubbard 1 2 , Lisa Kelly 1 , Annette Broome 1 2 , Amanda Henderson 1
  1. Princess Alexandra Hospital, Greenslopes, QLD, Australia
  2. The University of Queensland, Brisbane, QLD, AUS

Aims: To evaluate whether an Acute Cognition Unit (ACU) reduced severity of changed behaviours in hospitalised patients with dementia. To also investigate whether an ACU impacted rates of occupational violence, falls and pressure injuries reported on ‘ACU-feeder’ wards across the hospital.  

Methods: Implementation of an 8-bed dementia-enabling environmental design with its specialised model of care in a large metropolitan hospital. A single-case multiple baseline design measured changes in behaviour for all patients admitted to the ACU over a 2-year period (N=120). Each patient’s behaviour severity was measured every 4-days on the NPI,1 RAGE,2 and CMAI,3 from time of hospitalisation till discharge, capturing their transitions from ward-based care to ACU care. ACU admission criteria was independently mobile patients with dementia experiencing clinically significant changed behaviours. Paired t-tests compared each patient’s mean behaviour scores when receiving general ward care with that same patient’s ACU scores. Rates of occupational violence (OV), falls and pressure injury reported on three “ACU-feeder” wards were analysed 2-years pre-post ACU implementation.  

Results: Median length-of-stay in ACU was 21-days. Behaviours significantly decreased after admission to ACU (p<0.001). NPI scores decreased by 50% (figure 1), aggression by 56% (figure 2) and agitation by 28% (figure 3). Across three ‘feeder-wards’, falls decreased by 28.5% (p<0.001), pressure injuries by 24.6% (p<0.009) and OV in mobile patients with dementia, by 40% (p<0.034). 

Conclusions: The ACU was effective in treating changed behaviours while also demonstrating improved outcomes for general medical inpatients overall. This suggests benefits from reducing behaviour-related burden-of-care on medical wards. 

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  1. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory comprehensive assessment of psychopathology in dementia. Neurology 1994; 44(12): 2308-.
  2. Kupeli N, Vickerstaff V, White N, Lord K, Scott S, Jones L, et al. Psychometric evaluation of the Cohen‐Mansfield Agitation Inventory in an acute general hospital setting. International journal of geriatric psychiatry. 2018;33(1):e158-e65.
  3. Patel V, Hope R. A rating scale for aggressive behaviour in the elderly–the RAGE. Psychological medicine. 1992;22(1):211-21.