Caring for patients with dementia
in the acute care setting
Lesley Butcher

This article highlights the vulnerability of people with dementia in the acute
hospital setting, where they are more likely to experience clinical incidents
such as falls, contract infections and be prescribed neuroleptic drugs. This
patient group has a significantly longer length of hospital stay and higher
mortality rate following discharge compared with those without dementia. As
many as one third are discharged to institutionalised care. The article explores
the knowledge gap concerning the complexity of caring for a person with
dementia and highlights factors that can lead to staff detaching themselves
from engaging in meaningful communication with patients. It also discusses
the syndrome of ‘cascade iatrogenesis’ in relation to patients’ physical and
cognitive decline. More emphasis needs to be placed on addressing these
issues to ensure the safety and welfare of people with dementia in hospitals.
A case study from the author’s clinical practice is used to illustrate the issues.
Key words: Dementia ■ Vulnerable patients ■ Communication with patients
■ Cognitive impairment ■ Risk factors ■ Adverse events ■ Acute settings

D

ementia is a progressive clinical condition
that is experienced as an array of symptoms,
including memory loss, difficulty expressing
language, impaired communication and ability
to reason effectively. It can also be characterised
by changes to personality and mood. The main types are
Alzheimer’s disease (a condition that increases in severity),
vascular dementia, frontotemporal dementia, and dementia
with Lewy bodies (National Collaborating Centre for Mental
Health, 2007; Alzheimer’s Society, 2013). There is no known
cure for dementia (Livingston and Frankish, 2015).
Each form manifests in different ways and disease progression
varies between types of dementia. Lewy body dementia,
which is often associated with Parkinson’s disease, may cause
the person to experience visual hallucinations. Disturbances
to sleep patterns such as moving around or speaking at night
are also a feature of this disease (Walker et al, 2015). Those
with frontotemporal dementia may experience a significant
change in personality and behaviour, problems with language
production and verbal expression of words (Bang et al, 2015).

Lesley Butcher, Lecturer in Adult Nursing, Cardiff University,
School of Healthcare Sciences, Cardiff, ButcherL3@cardiff.ac.uk
Accepted for publication: January 2018

358

People with vascular dementia may have issues with urinary
urgency, frequency and urinary incontinence (Sakakibara, 2012).
They may become depressed, apathetic and more emotional than
is usual for them (Nina, 2014).These are just a few examples of
a complex condition that affects about 850 000 people in the
UK (Alzheimer’s Society, 2015).
Research suggests that one quarter of acute hospitals in the
UK are occupied by patients who have the condition, and it
highlights barriers to caring for people with dementia in this
setting (Alzheimer’s Society, 2009).These include environmental
unsuitability, staffing issues and lack of staff education in dementia
care (Houghton et al, 2016). Hospital staff feel inadequately
prepared to care for people with dementia (Allwood et al, 2017)
and some experience feelings of guilt regarding failure to meet
the needs of these patients (Clisset et al, 2013).
Poor outcomes associated with the hospitalisation of people
with cognitive impairment are well documented (Care Quality
Commission (CQC), 2013; Glover et al, 2014; George et al, 2013).
The reasons for this are not straightforward and consist of factors
that often feed into one another through the process of ‘cascade
iatrogenesis’ (Thornlow et al, 2009). From a nursing perspective,
it is vital to be aware of the vulnerability of those with dementia
who are hospitalised. It is essential for all staff to have an up-todate working knowledge of dementia, which should include an
understanding of the lived emotional experience of the person.
It is only then that we may communicate, support, advocate
and work in partnership with people living with this condition.

Setting the scene: an example from practice
Mrs M was admitted to a UK hospital after a fall. She was 82
years old, had vascular dementia and had been living at home
with her husband. Mrs M had moderate cognitive impairment,
but was mobile and was able to carry out her activities of daily
living with prompting and with support from her husband.
The assessment in hospital did not find a fracture, but the fall
had caused some soft tissue injuries and affected her confidence.
Mrs M also had a urinary tract infection (UTI), which had
most likely contributed to the fall, for which she was treated
with antibiotics. Physiotherapy was arranged, with a view to
drawing up a plan to go home. However, 7 weeks later Mrs M
remained in hospital and was referred for a nursing home
assessment. On review of the hospital notes over the 7 weeks,
there unfolded a story of decline, which changed the course of
Mrs M’s hospital stay, discharge plans and, ultimately, her life.
It was found that she:

© 2018 MA Healthcare Ltd

ABSTRACT

British Journal of Nursing, 2018, Vol 27, No 7
Downloaded from magonlinelibrary.com by 134.148.005.068 on April 23, 2018.

CLINICAL FOCUS

■■ Had poor eyesight, but had left her glasses in A&E, which

were subsequently lost
■■ Became agitated and more confused in the hospital environment
■■ Had no physiotherapy input as was deemed ‘non‑compliant’
■■ Was prescribed benzodiazepines for anxiety and restlessness
■■ Became sleepy and confined to bed
■■ Developed skin tears, requiring daily dressings to her legs
■■ Was given a urinary catheter for onset of incontinence
■■ Developed slight dysphagia and was prescribed a texture-E
(fork-mashable) diet
■■ Declined food and fluid, and lost 15 kg in 7 weeks
■■ Developed a grade-3 pressure ulcer on her sacrum
■■ Became tearful, withdrawn and non-communicative with staff.
It was evident that Mrs M’s condition had been reviewed
regularly during the ward round. However, each entry included
the phrase ‘Awaiting placement’, as opposed to any intervention
or input received. Disturbingly, on one occasion, a doctor had
written in the notes: ‘Mrs M is very tearful and upset because
she hasn’t seen her mother today. I reassured her that her mother
would have died quite some time ago.’
The word ‘reassured’ in this context was a paradox. There
appeared to be no understanding of Mrs M’s reality and how
best to communicate with her empathetically. Rather, there was
the expectation that a person with impaired cognition, in an
emotional state, should somehow accept a disturbing revelation,
forcing them into a reality within which they are unable to
function nor understand. Mrs M was discharged to a nursing
home and died within a few months. This scenario is not an
isolated or rare event.

Background
Historically, dementia care has not been prioritised by health
commissioners and government policymakers, which, in
Banerjee’s (2010) view, has been influenced by negative and
incorrect beliefs associated with dementia among both the
general public and health professionals. Myths such as ‘dementia is
a part of old age and nothing can be done’ have been perpetuated,
resulting in people with dementia missing out on essential care
to promote their wellbeing, crisis prevention and support for
families.

© 2018 MA Healthcare Ltd

Dementia care in acute settings
Outcomes for people with dementia are markedly poorer than
for other people, and they will have significantly longer length
of stays after an acute hospital admission than those admitted
for the same reason who do not have dementia (CQC, 2013).
They are more likely to be readmitted following discharge, and
a substantial number of people with dementia die in hospital
compared with those without dementia.An increased length of
stay in hospital for this group also worsens symptoms of cognitive
impairment, as well as physical health, and the probability of
discharge to a nursing home is high (Alzheimer’s Society, 2009).
Sampson et al (2013) showed that long-term survival is poor in
people with dementia, with almost half (48.3%) of those admitted
to an acute general hospital dying within a year of discharge.This
is half the survival rate of those without dementia. Morrison and
Siu (2000) studied the survival rate of patients with and without
British Journal of Nursing, 2018, Vol 27, No 7

dementia admitted following a hip fracture. After 6 months,
55% of those with dementia had died compared with 12% of
other patients. Likewise, the death rate for patients admitted for
pneumonia was 53% for those with dementia compared with
13% without after 6 months. Admissions of frail adults with
dementia are complex and often ‘complicated by falls, immobility,
pain, delirium, dehydration or incontinence’ (Glover et al, 2014).
Hospital acquired-delirium is common in patients with
dementia, but it is often not recognised or treated appropriately
(George et al, 2013). Likewise, adverse events such as medication
errors, infection and pressure ulcers are common with this
condition (Watkin et al, 2012). Despite this, review of clinical
incident reports revealed that staff appeared to have little
understanding that cognitive impairment was a risk factor for
such events (Watkin et al, 2012).
The CQC (2013) has raised concerns that 29% of people
with dementia admitted to hospital do not have their dementia
status recorded. Such under-recording can affect not only the
patient’s care, but the way hospitals ultimately prioritise funding,
staffing and training support for staff. People with dementia
are also more likely to have a poor experience of end-of-life
care (Davies et al, 2017): they are less likely to have advanced
end-of life care planning, be referred to palliative care services
and prescribed palliative care medications.

Why does this happen?
Thornlow et al (2009) describes a syndrome of ‘cascade
iatrogenesis’, whereby one relatively minor action or event
can trigger an ongoing progression of complications during the
hospital stay. It may begin with a nursing or medical intervention,
which unintentionally brings about a negative consequence:
one adverse event will lead to another, then another and so on.
In Mrs M’s case, her decline in function may have been initiated
by something as simple as losing her glasses.The subsequent lack
of vision, combined with unfamiliar people and surroundings,
was a recipe for severe anxiety for someone like Mrs M. In such
cases, if the anxiety is not met with appropriate support, this
can escalate to agitation. Misinterpretation of the agitation can
result in negative staff interactions, the introduction of sedatives
and decisions made as to the lack of rehabilitation potential.
Withdrawal of physiotherapy, plus the sedatives, inevitably leads
to reduced mobility, increased confusion and drowsiness. This,
in turn, can cause reduced appetite, dysphagia, poor nutrition
and eventually the development of pressure ulcers.
All these issues affect a patient’s cognitive impairment, leading
to more complications.The cascade effect continues, with medical
problems growing daily as the patient’s length of stay increases.

Unfamiliar environment
People living with dementia in their own homes may struggle,
but will cope well with the support of familiar people in a
familiar environment. However, hospital wards can be particularly
frightening places for anyone with dementia (Alzheimer’s Society,
2015). Changes to an environment can intensify confusion and
anxiety (Badrakalimuthu and Tarbuck, 2012). Someone like
Mrs M will already have heightened anxiety and confusion due
to the UTI and finding herself in alien surroundings.
359
Downloaded from magonlinelibrary.com by 134.148.005.068 on April 23, 2018.

Communication difficulties between staff and patient can be
caused by both parties misinterpreting the intended message and
give rise to ‘difficult behaviours’ (Young, 2012). Initial anxiety
may be exacerbated by personal care. For example, patients
might find themselves suddenly being stripped of clothing
and changed into a hospital gown by strangers, who fail to
take adequate time to explain what they are doing. Likewise,
it would be easy for a person living with cognitive impairment
to misinterpret an attempt to take blood for a test as an attempt
to cause harm, if the need for explanation and reassurance is
not considered.
Similarly, a patient’s frustration at not being able to express
that he or she is looking for the toilet might be compounded
by a member of staff ushering the person ‘safely’ back to bed,
without attempting to ascertain their need. In such cases, the
patient’s response might, understandably, be one of frustration.
The expression of agitation can often be a symptom of an
unmet care need causing distress (Dewing, 2010), which a staff
member without adequate knowledge and skills in dementia
care may misjudge as something else. Misunderstanding and
failing to communicate effectively with a person with dementia
can often be the trigger for aggressive outbursts (Chater and
Hughes, 2012).
Unmet care needs can also manifest as refusal to accept
interventions. For example, someone who needs the toilet, but
who is assisted to bed instead, might then have an episode of urinary
or faecal incontinence. If, at that time, a care worker places a plate
of food in front of the patient, the most likely response would be
to decline it. If the care worker then attempts to physically assist
the person to eat, the patient might push the spoon away or hit
out in agitation. They might shout for their partner, daughter or
anyone they associate with understanding them.
Due to the behaviours expressed, the person with dementia
will be at risk of being labelled as ‘challenging’ or ‘non-compliant’.
Although the use of such phraseology is now recognised as
inappropriate, documentation might suggest ‘refused food and
fluid’, ‘patient is wandering’ or ‘shouting and disrupting other
patients’ (Price, 2014). Ironically, the introduction of sedatives
might be considered to help ‘calm’ the person so they are more
amenable to accepting ‘care’.

Use of benzodiazepines and antipsychotics
The Alzheimer’s Society (2009) notes that antipsychotic
medication is used more commonly with people who have
dementia to treat behavioural symptoms. However, these drugs
are known to cause significant side effects such as oversedation,
dysphagia, Parkinsonism and stroke (George et al, 2013).They
are also known to increase mortality (Kales et al, 2012). Despite
the common use of antipsychotics, there is ‘limited evidence
of clinically meaningful benefit’ (Corbett et al, 2014). Only
risperidone is recommended in patients with severe aggression
or pre-existing psychiatric conditions, for a maximum of
12 weeks. Benzodiazepines are most commonly prescribed
in older people, however, paradoxically, this age group is more
susceptible to their adverse effects, such as drowsiness and fatigue,
and they are associated with a ‘5-fold increase of cognitive events’
360 

(McMillan et al, 2013) and a greater risk of falls (Echt et al,
2013). Prescribing these medications for people with dementia
would appear to be incongruous with their condition.

Personal barriers
Person-centred care is widely seen as the gold standard to caring
for those with dementia in any setting (National Institute for
Health and Care Excellence, 2016). However, a qualitative
observational study (Clissett et al, 2014) noted that staff were
missing opportunities to provide person-centred care. Health
professionals seemed ‘unable or unwilling’ to make a connection
with the person with dementia and chose to end interactions
quickly.There were observed incidences where attempts made
by patients to interact were invalidated by the staff member by
failing to acknowledge the person.
In the acute setting, the fact that the person has dementia
is often seen as ancillary to the reason for admission. Priority
is therefore given to medical care and nursing tasks, with the
extra needs of a person with dementia being seen as disruptive
to workload (Clissett et al, 2013). Health professionals admit
that they struggle to cope with cognitively impaired patients
who present with communication problems, confusion and
‘challenging behaviour’ (Alzheimer’s Society, 2009).
Sheard (2010) emphasised that people with dementia rely
more on ‘feelings’, as opposed to reason and logic, and explained
the importance of engaging in the emotional care of the person
with cognitive impairment. He also asserted that some health
professionals find emotional care threatening and tend to mask
their fear with ‘detached professionalism’. Dignity, respect and
compassion have always been central to nursing care (Blackhall
et al, 2011), however, they are not always demonstrated in
the care of people with dementia (Alzheimer’s Society, 2009).
Some nurses express feelings of guilt knowing that they are
not meeting the needs of patients with dementia, as they have
to prioritise people who are more medically unwell (Clissett
et al, 2014).
Takai et al (2009) explain that emotional strain, leading to
burnout, is common among caregivers of people with dementia,
stating that ‘extreme physical and mental fatigue, emotional
exhaustion, decreased work motivation and lack of empathy
towards others’ may be observed. Factors that affect a health
professional’s tendency to ‘burnout’ are complex and can be
influenced by external factors, life situation, as well as the
individual’s emotional resilience (Jackson et al, 2007). However,
given that health professionals struggle to cope well with caring
for a person with dementia, it is reasonable to assert that more
support and training is required not only to help patients but
also to retain staff and prevent burnout.
Knowing the theory behind dementia is only the tip of the
iceberg when it comes to enabling a person to feel confident
in working effectively with a person who has dementia.While
knowledge of different types of dementia and their specific
manifestations can be helpful, it is crucial to be competent
in the practical aspects of communication and approaches
to the delivery of care. In the view of Chater and Hughes
(2012), most nurses do want to learn the practical approaches
to communication and care.

© 2018 MA Healthcare Ltd

Misunderstandings in communication

British Journal of Nursing, 2018, Vol 27, No 7
Downloaded from magonlinelibrary.com by 134.148.005.068 on April 23, 2018.

CLINICAL FOCUS

Organisational barriers
Despite the desire many nurses have to improve care, without
organisational support, progress toward positive change in
dementia care will be limited (Sheard, 2014). Chief executives
and hospital managers need to promote a culture of change to
ensure that staff are well supported and trained appropriately,
and to minimise the risks to people with dementia.
Implementing a person-centred approach to the care of
patients with dementia can sometimes be undermined by
staffing shortages (Argyle, 2012).This can lead staff to feel under
pressure to provide adequate care for all patients. Organisations
often resort to using agency staff to provide one-to-one support
for patients with cognitive impairment who exhibit challenging
behaviours.A pilot study by Champion (2014) estimated that the
cost of such agency care amounted to £25 000 over a 6-month
period. This is not only costly, but fails to provide continuity
of care for patients with dementia, who need familiarity. Using
agency staff could also cause more confusion and distress for
patients. Arguably, the £25 000 might be better spent on
employing a regular member of staff for an entire year. This
would offer better continuity not only for patients, but also
within staff teams. Staffing in the NHS is a complex issue, and
it is crucial to ensure that there is provision to ensure people
with dementia receive high-quality care. Consistent and stable
staffing is key to this (National Collaborating Centre for Mental
Health, 2007), and will also contribute to reducing adverse
events and costly length of stay.

Conclusion
People with dementia who are admitted to acute care settings
have poorer outcomes than those without cognitive impairment.
The care of this patient group is complex and requires specialised
training to deliver high-quality provision. In acute hospitals, it
is essential that health professionals have an understanding of
cognitive impairment as a risk factor in itself. It is imperative
that staff have the right approach and are equipped with
good communication skills, which are critical in preventing
unnecessary medical complications that might not only lengthen
hospital stay, but also shorten the patient’s life. BJN

© 2018 MA Healthcare Ltd

Declaration of interest: none
Allwood R, Pilnick A, O’Brien R, Goldberg S, Harwood R, Beeke S. Should
I stay or should I go? How healthcare professionals close encounters with
people with dementia in the acute hospital setting. Soc Sci Med 2017; 191:
212–25. https://doi.org/10.1016/j.socscimed.2017.09.014
Alzheimer’s Society. Dementia 2015: Aiming higher to transform lives. 2015.
https://tinyurl.com/yccyrhku (accessed 12 March 2018)
Alzheimer’s Society. Dementia 2013: The hidden voice of loneliness. 2013.
https://tinyurl.com/y89ujjr7 (accessed 12 March 2018)
Alzheimer’s Society. Caring for people with dementia on hospital wards. 2009.
https://tinyurl.com/ya8s4y84 (accessed 12 March 2018)
Argyle E. Person centred dementia care: problems and possibilities.
Working with Older People 2012; 16(2): 69–77. https://doi.
org/10.1108/13663661211231828
Badrakalimuthu V, Tarbuck A. Anxiety: a hidden element in dementia. Advances
in Psychiatric Treatment 2012; 18: 119–28. https://doi.org/10.1192/apt.
bp.110.008458
Banerjee S. Living well with dementia—development of the national dementia
strategy for England. Int J Geriatr Psychiatry 2010; 25: 917–22. https://doi.
org/10.1002/gps.2598
Bang J, Spina S, Miller B. Frontotemporal Dementia. Lancet 2015; 383(10004):
1672–82. https://doi.org/10.1016/S0140-6736(15)00461-4

British Journal of Nursing, 2018, Vol 27, No 7

KEY POINTS
■■ People with dementia are more likely to experience clinical incidents such

as falls, contract infections and be prescribed neuroleptic drugs in the
clinical setting
■■ ‘Cascade iatrogenesis’can occur in patients with dementia
■■ Changes to an environment can intensify confusion and anxiety
■■ People with dementia who are admitted to acute care settings have poorer

outcomes than those without cognitive impairment
■■ In acute hospitals, it is essential that health professionals have an

understanding of cognitive impairment as a risk factor in itself
Blackhall A, Hawkes D, Hingley D, Wood S. VERA framework: communicating
with people who have dementia. Nurs Stand 2011; 26(10): 35-9. https://doi.
org/10.7748/ns2011.11.26.10.35.c8818
Care Quality Commission. Care Update. London: CQC; 2013. https://tinyurl.
com/y87qohar (accessed 12 March 2108)
Champion E. Person-centred dementia care in acute settings. Nurs Times 2014;
110(37): 23-5
Chater K, Hughes N. Strategies to deliver dementia training and education
in the acute hospital setting. Journal of Research in Nursing 2012; 18(6):
578–93. https://doi.org/10.1177/1744987112446242
Clissett P, Porock D, Harwood R, Gladman J. The challenges of achieving
person-centred care in acute hospitals: a qualitative study of people with
dementia and their families. Int J Nurs Stud 2013; 50(11): 1495–503. https://
doi.org/10.1016/j.ijnurstu.2013.03.001
Clissett P, Porock D, Harwood R, Gladman J. The responses of healthcare
professionals to the admission of people with cognitive impairment to acute
hospital settings: an observational and interview study. J Clin Nurs 2014;
23(13–14): 1820–9. https://doi.org/10.1111/jocn.12342
Corbett A, Burns A, Ballard C. Don’t use antipsychotics routinely to treat
agitation and aggression in people with dementia. BMJ 2014;349:g6420.
https://doi.org/10.1136/bmj.g6420
Davies N, Rait G, Maio L, lliffe S. Family caregivers’ conceptualisation of quality
end-of-life care for people with dementia: a qualitative study. Palliat Med
2017; 31(8): 726–33. https://doi.org/10.1177/0269216316673552
Dewing J. Responding to agitation in people with dementia. Nurs Older People
2010; 22(6): 18–25. https://doi.org/10.7748/nop2010.07.22.6.18.c7837
Echt MA, Samelson EJ, Hannan MT, Dufour AB, Berry SD. Psychotropic drug
initiation or increased dosage and the acute risk of falls: a prospective cohort
study of nursing home residents. BMC Geriatr 2013; 13(19). https://doi.
org/10.1186/1471-2318-13-19
George J, Long S,Vincent C. How can we keep patients with dementia safe in
our acute hospitals? A review of challenges and solutions. J R Soc Med 2013;
106(9): 355–61. https://doi.org/10.1177/0141076813476497
Glover A, Bradshaw LE, Watson N et al. Diagnoses, problems and healthcare
interventions amongst older people with an unscheduled hospital admission
who have concurrent mental health problems: a prevalence study. BMC
Geriatr 2014; 14(43). https://doi.org/10.1186/1471-2318-14-43
Houghton C, Murphy K, Brooker D, Casey D. Healthcare staff ’s experiences
and perceptions of caring for people with dementia in the acute setting:
qualitative evidence synthesis. Int J Nurs Stud 2016; 61: 104–16. https://doi.
org/10.1016/j.ijnurstu.2016.06.001
Livingston G, Frankish H. A global perspective on dementia care: a Lancet
Commission. Lancet 2015; 386(9997): 933–4. https://doi.org/10.1016/
S0140-6736(15)00078-1
Kales HC, Kim HM, Zivin K et al. Risk of mortality among individual
antipsychotics in patients with dementia. Am J Psychiatry 2012; 169(1): 71–9.
https://doi.org/10.1176/appi.ajp.2011.11030347
McMillan JM, Aitken E, Holroyd-Leduc JM. Management of insomnia and
long-term use of sedative-hypnotic drugs in older patients. CMAJ 2013;
185(17): 1499–505. https://doi.org/10.1503/cmaj.130025
Morrison RS, Siu AL. Survival in end-stage dementia following acute illness.
JAMA 2000; 284(1): 47–52. https://doi.org/10.1001/jama.284.1.47
National Institute for Health and Clinical Excellence (2016) Dementia:
Supporting people with dementia and their carers in health and social care.
clinical guideline [CG42]. https://tinyurl.com/nub9n9l (accessed 12 March
2018)
Nina RE. Depression and vascular dementia’. Alzheimer’s and Dementia 2014;
10(4): 523–4. https://doi.org/10.1016/j.jalz.2014.05.818
Sakakibara R, Panicker J, Fowler CJ et al.Vascular incontinence: incontinence in
the elderly due to ischemic white matter changes. Neurol Int 2012; 4(2):e13.
https://doi.org/10.4081/ni.2012.e13

361
Downloaded from magonlinelibrary.com by 134.148.005.068 on April 23, 2018.

CPD reflective questions
■■ Have you ever struggled to provide adequate care for a patient with dementia? What were the factors that made it

difficult?
■■ How can you tailor your communication methods to help support patients with dementia?
■■ What are the patient safety issues need to be considered when caring for patients with dementia?

Sampson EL, Leurent B, Blanchard MR, Jones L, King M. Survival of people
with dementia after unplanned acute hospital admission: a prospective
cohort study. Int J Geriatr Psychiatry 2013; 28(10): 1015–22. https://doi:.
org/10.1002/gps.3919
Sheard D. Achieving culture change: a whole organisation approach. Nursing
and Residential Care 2014; 16(6): 329–32. https://doi.org/10.12968/
nrec.2014.16.6.329
Sheard D. The task is the mask. Signpost: Journal of Dementia and Mental
Health Care of Older People 2010; 15(1): 3-6.
National Collaborating Centre for Mental Health. Dementia. The NICE-SCIE
guideline on supporting people with dementia and their carers in health and
social care. 2007. https://tinyurl.com/y7kh6bm4 (accessed 12 March 2018)
Takai M, Takahashi M, Iwamitsu Y et al. The experience of burnout among
home caregivers of patients with dementia: relations to depression and
quality of life. Arch Gerontol Geriatr 2009; 49(1): e1–5. https://doi.
org/10.1016/j.archger.2008.07.002

Thornlow D, Anderson R, Oddone E. Cascade iatrogenesis: factors leading to
the development of adverse events in hospitalized older adults. Int J Nurs
Stud 2009; 46(11): 1528–35. https://doi.org/10.1016/j.ijnurstu.2009.06.015
Walker Z, Possin KL, Boeve BF, Aarsland D. Lewy body dementias. Lancet 2015;
386(10004): 1683–97. https://doi.org/10.1016/S0140-6736(15)00462-6.
Watkin L, Blanchard MR, Tookman A, Sampson EL. Prospective cohort study
of adverse events in older people admitted to the acute general hospital: risk
factors and the impact of dementia. Int J Geriatr Psychiatry 2012; 27(1):
76–82. https://doi.org/10.1002/gps.2693
Young T. Devising a dementia toolkit for effective communication. Nursing
and Residential Care 2012; 14(3): 149–51. https://doi.org/10.12968/
nrec.2012.14.3.149

Neuroscience Nursing:
assessment and patient management
Edited by Sue Woodward
An essential reference text for nurses working with people
with neurological problems in a variety of settings.
Composed of the best articles on neuroscience nursing
published in the British Journal of Nursing, it is the first of
its kind and focuses on:
■ Aspects of assessment relevant to neurological patients
■ Issues in the management of patients with acute
neurological conditions
■ The management of patients with long-term
neurological conditions.
It includes a selection of case studies to illustrate the main points.

362

Order your copies by visiting

or call our Hotline

www.quaybooks.co.uk

+44(0)1722 716 935

© 2018 MA Healthcare Ltd

ISBN 13: 978-1-85642-308-3; 190 x 245mm; paperback; 400 pages;
publication 2006; £39.99

British Journal of Nursing, 2018, Vol 27, No 7
Downloaded from magonlinelibrary.com by 134.148.005.068 on April 23, 2018.