MHA Workgroup Creates Guidance for Dementia Care

The MHA Alzheimer’s and Related Dementias Workgroup – which met from December 2017 through the summer of 2018 – has developed a guidance document to assist hospitals with implementing care and management practices for patients with Alzheimer’s and related dementias.

This 25-page document – Guidance for Developing an Operational Plan to Address Diagnosis and Care for Patients with Alzheimer’s Disease and Related Dementias in Hospital Settings – is based on recommendations from the state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee.

There are several forms of dementia, the most common of which is Alzheimer’s disease. However, hospitals also treat patients who suffer from delirium, which is separate and distinct from dementia. Unlike dementia, delirium – which is common in hospitalized patients with dementia – is a temporary condition and may be preventable. The MHA guidance addresses both dementia and delirium in patients in hospital emergency departments and inpatient units.

According to the federal CDC, Alzheimer’s is among the 10 leading causes of deaths in the U.S. and the latest figures (from 2017) show that deaths from Alzheimer’s increased 2.3% from the previous year.
Clinicians and a patient and family representative from 11 Massachusetts hospital and health systems, and members of the Alzheimer’s Association – MA/NH Chapter, served on the MHA workgroup, contributing expertise on the following six broad components:

1. The need to provide culturally sensitive training on dementia and/or delirium to a broad range of caregivers;
2. The importance of providing the optimal environment for patients, which may include sound reduction measures and special lighting;
3. The necessity of learning the patient’s prior history by working with the patient, family, caregivers, EMS personnel, among others;
4. Management of treatment once the patient is in the care of providers in the hospital;
5. Improving communication in care transfers and in discharges; and
6. Incorporating advanced care planning into the general information provided to a patient and caregivers to ensure that patients with Alzheimer’s and related dementias have the full resources available to them.

Each broad recommendation is accompanied by a list of the care team members who would be involved in carrying out the guidance, suggested action steps, and resources to assist hospitals in adopting or revising their clinical and operational dementia care practices.

In June 2017, the Massachusetts Alzheimer’s and Related Dementias Acute Care Advisory Committee (jointly coordinated by DPH and the Executive Office of Elder Affairs) issued statewide recommendations for acute care hospitals to address dementia care.  The committee was composed of healthcare clinicians from MHA member hospitals, family caregivers, patient advocates, researchers, and state agencies. As result of the recommendations, several provider and advocacy groups worked with the legislature to pass Chapter 220 of the Acts of 2018, which created a new statewide advisory council to coordinate the development of Alzheimer’s and other related dementias services. 

Chapter 220 requires every hospital licensed by DPH to implement by October 1, 2021, an operational plan for the recognition and management of patients with dementia or delirium in acute care settings.  The law became effective November 7, 2018.