UNC School of Medicine initiative providing unique care to dementia patients

The Dementia Friendly Hospital Initiative will reach a total of 3,900 employees in four hospitals across North Carolina to raise awareness of how patients with dementia experience care, and to meet their unique needs with strategic and compassionate treatment. Led by the Division of Geriatric Medicine and Center for Aging and Health in the UNC School of Medicine, the program will deliver dementia-friendly training to targeted UNC Health Care system hospitals, and could reach nearly 5,500 patients aged 65 years and older with dementia every year.

The program is being piloted at UNC Hospitals Hillsborough Campus and aims to improve care for a rapidly expanding population of patients affected by Alzheimer's disease and related dementias (ADRD). ADRD is the sixth leading cause of death nationally and the only leading cause of death for which there is no cure. One in three seniors who die each year have ADRD. Patients with dementia have prolonged hospital stays, increased 30-day readmissions, poorer health outcomes and higher mortality rates.

With an Alzheimer's diagnosis, the chance of being hospitalized also increases significantly. Yet routine hospital procedures can create confusion, agitation and fear in patients with dementia, because they may not have the ability to understand what is happening to them. Reactions span a range of behaviors such as yelling, striking out, pulling at IVs, or trying to leave their beds and rooms.

"Imagine if you don't know what's going on. You're in this strange place and you don't remember how you got there. You're connected to wires, the lights are bright, or the room is dark, and people are doing things to you that you don't understand," said Krista Wells, a clinical nurse education specialist at UNC's Hillsborough Campus. "With a dementia patient, their common reaction is often to lash out and tell people to 'leave me alone, stop bothering me.'"

"Hospitalization can be traumatic for patients with dementia and challenging for caregivers and families," said Jan Busby-Whitehead, MD, principal investigator for the Dementia Friendly Hospital Initiative. "There is much we can do to improve experiences and outcomes for these patients. The Dementia Friendly Hospital Initiative moves beyond a provider-centric focus to involve the whole hospital in connecting effectively with patients with dementia and making them feel safe and well cared for," said Busby-Whitehead, who is also chief of the UNC School of Medicine's Division of Geriatric Medicine and director for the School's Center for Aging and Health.

The Dementia Friendly Hospital Initiative targets the entire span of patient and family interactions that occur during hospitalization. All staff who interact in any way with patients - from physicians and advanced practice providers to food service workers, security officers, and administrators - will be trained in strategies to improve quality and safety. The program also seeks to lower rates for in-hospital injuries, length of stay and 30-day readmissions.