FC27: Golden Angels: The impact of volunteer support for patients with dementia and delirium in Australian rural hospitals

Abstract

Objectives:

evaluate the clinical outcomes for acute hospital patients with dementia, delirium or at risk for delirium supported by the person-centred volunteer program in australian rural hospitals.

Design:

a non-randomised, mixed methods, controlled trial.

Participants:

older adults admitted to 7 rural acute hospitals. Intervention (n=270) patients were >65 years with a diagnosis of dementia and/or delirium or had risk factors for delirium and received volunteer services. Family carers (n=83) of intervention patients were interviewed. Staff survey and focus groups. Control (n=188) patients were randomly drawn from patients admitted to the same hospital 12 months prior to the volunteer program who would have met program eligibility criteria.

Intervention:

trained volunteers provided 1:1 person centred care with a focus on nutrition and hydration support, hearing and visual aids, activities, and orientation.

Measures:

medical record audits provided data on volunteer visits, diagnoses, length of stay (los), behavioural incidents, readmission, specialling, mortality, admission to residential care, falls, pressure ulcers and medication use.

Results:

across all sites there was a significant reduction in rates of 1:1 specialling (p=.011) and 28 day readmission (p=.006) for patients receiving the volunteer intervention. Los was significantly shorter for the control group (p=.001). All other patient outcomes were equivalent for the intervention and control group (p>.05). Volunteers integrated themselves into the care team providing person-centred care, increased safety and quality of care and were an “extra pair of hands”, reducing care burden for staff and importantly for families: “for me, knowing someone was there … i can't even tell you what a benefit that was”. 98% of staff rated the program as supportive of them in their care

Enablers were clear processes for screening, training and supporting volunteers. Key challenges included initial role delineation, staff/volunteer trust and sustainability.

Conclusion:

appropriately trained and supported volunteers are cost effective and can improve the safety and quality of care for hospitalised patients with cognitive impairment in rural hospitals.