2024 Alzheimer's Association Research Grant (AARG)
Innovating the Evaluation of Rejection of Care in Hospital Dementia Care
How can we assess when people with dementia refuse care in hospitals?
Clarissa Shaw, Ph.D., RN
The University of Iowa
Iowa City, IA - United States
Background
Individuals with dementia are twice as likely to be hospitalized as people without dementia. Further, individuals with behavioral and psychological symptoms related to dementia have longer hospital stays, higher readmission rates, and higher discharge rates. Rejection of care (RoC) is when a person opposes the efforts of a caregiver, sometimes through hitting or yelling, which interferes and disrupts medical care. Reducing rejection of care could improve healthcare and decrease costs for individuals with dementia.
In preliminary studies, Dr. Clarissa Shaw and colleagues showed that rejection of care is preventable. They found that 25% of nursing staff use “elderspeak,” a form of communication that sounds like baby talk, when caring for people with dementia. Reducing elderspeak led to a 77% decrease in rejection of care. The research team also established a method to track rejection of care in hospital electronic records, which they call EMRoC.
Research Plan
Dr. Shaw and colleagues will compare EMRoC to an established measure of rejection of care, called the Resistiveness to Care Scale. They will assess 230 care encounters (physical care between the nursing staff and a person with dementia) at ten participating medical-surgical hospital units at the University of Iowa Hospitals and Clinics.
Additionally, the research team will develop a statistical model to determine if certain interventions can reduce an individual nurses’ propensity for eliciting rejection of care.
Impact
Results from this study could help hospital systems measure rejection of care in people with dementia, as well as assess the impact of individual nurses on the behavior of people with dementia. This could improve healthcare for people with dementia and reduce costs.