North Carolina is not unlike the rest of the country when it comes to trends of increasing rates of Alzheimer’s disease or a related dementia. Nearly six million Americans live with Alzheimer’s disease; by 2050, the number will jump to 14 million. In just six years, the percentage of North Carolinians 65 and older with Alzheimer’s disease or related dementia (ADRD) will increase by nearly 24 percent.
Currently, for every 1,000 North Carolinians with dementia, there are 1,615 emergency department visits. Patients with dementia are not only hospitalized more often, they spend more time in the hospital per visit. The increased rate of dementia means that increasing numbers of older North Carolinians will be at risk for the injuries and illness that come with hospitalization: falls, dehydration, pressure ulcers, and delirium, a state of confusion that comes on suddenly and can last for days.
UNC Center for Aging and Health’s Dementia-Friendly Hospital Initiative is using online modules and face-to-face training to equip physicians and staff with tools and approaches to improve care for the rapidly expanding population of patients living with ADRD. The Duke Endowment-funded initiative is currently in the pilot phase at UNC Hospitals Hillsborough campus, known for its commitment to improving care for older adults.
John Gotelli, Nurse Practitioner at UNC Hospitals Inpatient Geriatrics Service, leads the Dementia-Friendly Hospital Initiative’s face-to-face training, and Dr. Maureen Dale, Assistant Clinical Professor in the Division of Geriatric Medicine and Medical Director of Inpatient Geriatrics Service, serves on the steering committee for the Duke Endowment grant. The dementia-friendly training design empowers the hospitals to make changes that will mitigate risk for older patients. It does this by training the entire staff at the UNC Hospitals Hillsborough campus – from kitchen staff, to physicians, to housekeeping, to the nursing team. For example, members of the housekeeping team learn the benefit of entering the room of a patient with dementia by first turning on the lights, immediately announcing him or herself, and telling the patient what they are doing as they are cleaning the room. Gotelli emphasizes that this approach to all staff training represents a cultural shift in the hospitals.
Dr. Dale describes the training as a jolting reminder that if a patient does not remember that he or she is in the hospital, the simple act of a nurse coming in to check blood sugar or a housekeeper emptying a trashcan is incredibly alarming. “As UNC Hospitals cares for more older adults with cognitive impairment, we need to make sure we are caring for them in a way that is going to help them,” says Dr. Dale.
The Dementia-Friendly Hospital Initiative creates a space for all hospital staff to improve care of patients with dementia. Both Gotelli and Dale share that some of the most innovative recommendations have come from staff who do not have a physician relationship with patients. For instance, a group of food services employees and certified nursing assistants suggested moving away from using white and cream plates, which make it difficult for a person with dementia to differentiate between foods, to using plates with an array of bold colors. The simple change of plate colors has made it much easier for patients to process the visual input and enjoy their meals. They also suggested a finger food menu to make it easier for patients to feed themselves. “It was their knowledge and understanding of dementia that led to these ideas being put into practice at the Hillsborough campus”, says Gotelli.
Since launching the pilot in January 2019, the training has reached 460 of Hillsborough campus’s 500 employees, but the impact of the training is not just about the numbers. Dr. Dale sees this when she is on rotation. “What’s most moving is that now when I’m in the hospital, I see these little moments of care that stem from the training. I see nurses encouraging patients to reminisce or singing a song from the patient’s past together. We’re putting the strategies into practice.”
The Initiative will spread both locally and statewide in its next phase, which will work with UNC Memorial Hospital in Chapel Hill, Pardee UNC Health Care in Hendersonville, and Wayne UNC Health Care in Goldsboro. Ultimately, the Dementia-Friendly Hospital Initiative will create a lasting movement by getting dementia-friendly training modules to all UNC Hospitals and affiliates, and then supporting each site as they develop and implement their own innovative approaches to improving care for patients with dementia.
For more information on how to support the UNC Center for Aging and Health and the Dementia-Friendly Hospital Initiative, please contact Beth Braxton, Director of Development, at 919-843-8254 or beth_braxton@med.unc.edu.
2 Responses to “Innovative Approaches: UNC’s Dementia-Friendly Hospital Initiative”
Mitch saffie
I am a R.N @ Carolina meadows and will send my weekend emergencies to Hillsboough
Janice Rickey
Thank you for this research and training. My mother had a terrible experience at NHRMC the last time she was in the ER and on the floor. One of the recommendations I made in my letter to the hospital was for training on handling dementia patients.