Supportive Interventions Involving Family Carers of Patients With Delirium Superimposed on Dementia in Hospital: A Scoping Review

Abstract

Background

People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.

Aim

To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.

Methods

We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).

Results

Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.

Conclusion

This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.

Relevance to Clinical Practice

The review findings provide evidence for clinical practice when selecting existing interventions and approaches involving family in supporting patients with DSD.

Patient or Public Contribution

Not required as this was a review, not an original piece of research.