Italian DemENTia frIendly hospiTal triAl (IDENTITÀ): efficacy of a dementia-friendly intervention on patients and hospital staff

Dementia is becoming increasingly common in the ageing population, and its prevalence has been estimated to double by around 2050 (WHO, 2018). The most frequent service users in the acute hospital are people with cognitive and functional decline (Briggs, et al., 2015). The complexity of clinic situation of older patients with dementia contributes to longer hospitalization compared to older adults without cognitive decline, and this has an impact on a patient’s physical and mental state (Draper et al., 2011; Zuliani et al., 2011). Hospitalization of elderly people is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge and has been identified as a potential risk factor for depressive symptoms in older adults (Admi et al., 2015). Moreover, age, low basic and instrumental activities of daily life, and low cognitive status were significant factors of functional decline during hospitalization (Hoogerduijn et al., 2006). Previous studies showed that dementia-friendly initiatives have positive effects on functional and well-being of elderly people with dementia. Dementia Friends is an initiative by the Alzheimer’s Society that aims to give people a better understanding of dementia. It’s important that people with dementia receive appropriate healthcare services in the same way as any other patient (Lin S.-Y. , 2017). Despite a number of studies tested the effectiveness of a dementia-friendly intervention evaluating changes in hospital staff (e.g. (Banks, et al., 2014); (Elvish R. , et al., 2014); (Galvin, et al., 2010); (Palmer, et al., 2014) & (Surr, Smith, Crossland, & Robins, 2016)), very few studies evaluated the effect of a dementia-friendly intervention directly on patients' outcomes (Boltz, Chippendale, Resnick, & Galvin, 2015). For these reasons, the aim of the present study was to test the effectiveness of a dementia care intervention called “Italian DemENTia friendly hospiTal triAl (IDENTITÀ)” to significantly improve the cognitive-functional state and the quality of care of elderly hospitalized patients with cognitive impairments. This was the first Italian study about Dementia-Friendly approach in hospital. To the best of our knowledge, no studies have investigated both differences in older adults’ well-being state during hospitalization comparing those affected by cognitive and no cognitive impairment, also looking at the relationship with other health-related factors; and knowledge, approach and self-confidence of hospital staff in treating patients with dementia and trained them. We recruited 128 elderly patients over 65 years in two groups with and without Cognitive Impairment who has been hospitalized in four medical units of a public hospital located in Italy: General medicine ward, Surgical ward, Orthopedics ward and Cardiac ward. We also recruited 93 hospital staff participants working at one of the same wards in which we recruited patients. We tested elderly patients both at pre-test and at post-test in Mini Mental State Examination (MMSE) to assess cognitive functions, Hospital Anxiety and Depression Scale (HADS) for anxiety and for depression, BARTHEL Modified Index and Instrumental Activity of Daily Living (IADL) for the assessment of functional and instrumental activity of daily living, respectively. We also used patient’s clinical reports and Charlson Comorbidity Index (CCI). We tested hospital staff at pre-test, post-test and follow-up on the Approach to Dementia Questionnaire (ADQ) to assess hospital staff attitude towards patients with Cognitive Impairment, the Confidence in Dementia Scale (CODE) to assess the confidence in working in hospital staff toward hospitalized patients with dementia and the Dementia Knowledge – 20 (DK-20) to assess hospital staff knowledge about dementia.