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    Evaluation of a medical and mental health unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': A controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

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    Author
    Jones, Rob G.
    Keyword
    Delirium
    Dementia
    Hospital emergency service
    Patient admission
    Health services for the aged
    Research design
    Date
    2011
    
    Metadata
    Show full item record
    DOI
    10.1186/1745-6215-12-123
    Publisher's URL
    https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-12-123
    Abstract
    Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.
    Citation
    Harwood, R. H., Goldberg, S. E., Whittamore, K. H., Russell, C., Gladman, J. R. F., Jones, R. G., Porock, D., Lewis, S. A., Bradshaw, L. E., Elliot, R. A., et al. (2011). Evaluation of a medical and mental health unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': A controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit. Trials, 12, pp.11.
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/10277
    Note
    © 2011 Harwood et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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