Evaluation of Nursing Care Quality for Alzheimer's Patients During Hospitalization
Abstract:
Alzheimer's disease constitutes one of the most challenging medical conditions of our time, requiring specialized care during hospitalizations. This study evaluated family members' perceptions of nursing care quality provided to hospitalized Alzheimer's patients. A cross-sectional descriptive quantitative design was used with 85 family members of Alzheimer's patients at a private hospital institution in San Juan, Puerto Rico, during June-December 2024. A validated 34-item questionnaire was applied evaluating four dimensions: physical care, emotional/psychological care, communication quality, and general satisfaction. Results revealed a regular perception of care quality (average 3.1/5.0) with significant variations between dimensions. Communication emerged as the main strength (3.5/5.0, 50.6% satisfaction), while emotional/psychological care represented the greatest deficiency (2.6/5.0, 55.3% dissatisfaction). Significant positive correlations were identified between all dimensions (p<0.01), with the strongest being between physical care and general satisfaction (r=0.724). The most influential sociodemographic factors were time elapsed since diagnosis (strong negative effect) and family member's educational level (positive effect). Spouses evaluated care significantly more positively than daughters and cousins. The findings offer evidence for designing strategies that improve emotional care and strengthen communication, contributing to knowledge about care quality in patients with dementia.
KeyWords:
Alzheimer's, nursing care, quality of care, family perspective, hospitalization
References:
- Al-Hussami, M., Hammad, S., Alshammari, F., & Alhalaiqa, F. (2023). Knowledge and attitude toward people with Alzheimer's disease among Jordanian nurses. Nursing Forum, 58(1), 52–59. https://doi.org/10.1111/nuf.12785
- Alzheimer's Association. (2018). Dementia care practice recommendations. https://www.alz.org/professionals/professional-providers/dementia_care_practice_recommendations
- Alzheimer's Association. (2025). 2025 Alzheimer's disease facts and figures. https://www.alz.org/alzheimers-dementia/facts-figures
- Boddington, P., & Featherstone, K. (2018). The canary in the coal mine: Continence care for people with dementia in acute hospital wards as a crisis of dehumanization. Bioethics, 32(4), 251–260. https://doi.org/10.1111/bioe.12446
- Cabrera Carreño, V. C. (2022). Cuidado humanizado de enfermería en pacientes con Alzheimer [Bachelor's thesis, Jipijapa-Unesum]. https://repositorio.unesum.edu.ec/bitstream/53000/3917/1/TESIS%20VALERIA%20CABRERA%20C.pdf
- Çevik, B., Kav, S., Akgün Çıtak, E., Akyüz, E., & Abbasoğlu, A. (2022). Challenges of providing nursing care to patients with dementia: A qualitative study. European Journal of Geriatrics and Gerontology, 4(3), 205-211. https://doi.org/10.4274/ejgg.galenos.2022.2022-6-3
- Díaz Usme, O. S. (2020). Dimensiones de cuidado de enfermería a la persona con diagnóstico de enfermedad de Alzheimer: Una mirada desde enfermería [Master's thesis]. Universidad El Bosque.
- Digby, R., Lee, S., & Williams, A. (2017). The experience of people with dementia and nurses in hospital: An integrative review. Journal of Clinical Nursing, 26(9-10), 1152–1171. https://doi.org/10.1111/jocn.13429
- Dookhy, J., & Daly, L. (2021). Nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study. International Journal of Older People Nursing, 16(4), e12379. https://doi.org/10.1111/opn.12379
- Francia Luna, L. M. (2020). Comunicación asertiva y apoyo emocional de enfermería según el familiar del paciente crítico, Hospital Sergio Bernales–Lima, 2020.http://repositorio.autonomadeica.edu.pe/bitstream/20.500.14441/724/3/Lisset%20Magaly%20Francia%20Luna.pdf
- Guerrero-Ramírez, R., Meneses-La Riva, M. E., & De La Cruz-Ruiz, M. (2017). Cuidado humanizado de enfermería según la teoría de Jean Watson, servicio de medicina del Hospital Daniel Alcides Carrión. Lima- Callao, 2015. Revista de Enfermería Herediana, 9(2), 133. https://revistas.upch.edu.pe/index.php/RENH/article/view/3017
- Helgesen, A. K., Larsen, D. W., & Grøndahl, V. A. (2020). Quality of care in a nursing home as experienced by patients with dementia. Journal of Multidisciplinary Healthcare, 13, 1947-1955.
- Herring, W. L., Gould, I. G., Fillit, H., Lindgren, P., Forrestal, F., Thompson, R., & Pemberton-Ross, P. (2021). Predicted lifetime health outcomes for aducanumab in patients with early Alzheimer's disease. Neurology and Therapy, 10(2), 919-940. https://doi.org/10.1007/s40120-021-00273-0
- Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A.,Brayne, C., & Fox, N. C. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572-628.
- Moody, E., McDougall, H., Weeks, L. E., Belliveau, A., Bilski, P., Macdonald, M., Williams, L., Khanna, I., Jamieson, H., Bradbury, K., Rothfus, M., Koller, K., & Adisaputri, G. (2024). Nursing interventions to improve care of people living with dementia in hospital: A mixed methods systematic review. International Journal of Nursing Studies, 158, 104838. https://doi.org/10.1016/j.ijnurstu.2024.104838
- Moyle, W. (2023). Grand challenge of maintaining meaningful communication in dementia care. Frontiers in Dementia, 2, 1137897. https://doi.org/10.3389/frdem.2023.1137897
- Naranjo-Hernández, Y., & Pérez-Prado, L. Y. (2021). Cuidado del paciente con enfermedad de Alzheimer. Revista Archivo Médico de Camagüey, 25(1), e7737. http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S1025-02552021000100014
- Oliveira Farfán, D., Rocha, J. F. D., Silva, M. E. D. C., Vasconcelos, S. C. D., & Andrade, E. M. L. R. D. (2017). Cuidados de enfermería a personas con demencia de Alzheimer. Revista Cuidarte, 8(2), 1444-1456.Pintado, L. (2017). Estrategias de comunicación utilizadas con adultos mayores por el personal de enfermería [Doctoral dissertation, Universidad del Turabo]. https://documento.uagm.edu/gurabo/salud/tesis/Lillian-Pintado-Elismarie-Calero-Ondina-Vega-PHL-2017.pdf
- Røsvik, J., & Rokstad, A. M. M. (2020). What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature. BMC Health Services Research, 20, 723. https://doi.org/10.1186/s12913-020-05618-3
- Scerri, A., Innes, A., & Scerri, C. (2020). Person-centered dementia care in acute hospital wards-The influence of staff knowledge and attitudes. Geriatric Nursing, 41(3), 215–221. https://doi.org/10.1016/j.gerinurse.2019.09.001
- Scerri, A., Innes, A., & Scerri, C. (2017). How people with dementia and nurses view acute hospital care: An integrative review. Journal of Clinical Nursing, 26(9–10), 1152–1171. https://doi.org/10.1111/jocn.13429
- Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019). Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Medicine, 17, 1-13.
- Tasseron-Dries, P. E. M., Smaling, H. J. A., Nakanishi, M., Achterberg, W. P., & van der Steen, J. T. (2023). What are best practices for involving family caregivers in interventions aimed at responsive behaviour stemming from unmet needs of people with dementia in nursing homes: A scoping review. BMJ Open, 13(12), e071804. https://doi.org/10.1136/bmjopen-2023-071804
- Toles, M., Song, M. K., Lin, F. C., & Hanson, L. C. (2018). Perceptions of family decision-makers of nursing home residents with advanced dementia regarding the quality of communication around end-of-life care. Journal of the American Medical Directors Association, 19(10), 879-883.
- Turner, A., Eccles, F. J., Elvish, R., Simpson, J., & Keady, J. (2017). The experience of caring for patients with dementia within a general hospital setting: A meta-synthesis of the qualitative literature. Aging & Mental Health, 21(1), 66–76. https://doi.org/10.1080/13607863.2015.1109057
- U.S. Department of Health and Human Services. (2021). National plan to address Alzheimer's disease: 2021 update. https://aspe.hhs.gov/reports/national-plan-2021-update
- Yates, J., Stanyon, M., Samra, R., & Clare, L. (2021). Challenges in disclosing and receiving a diagnosis of dementia: A systematic review of practice from the perspectives of people with dementia, carers, and healthcare professionals. International Psychogeriatrics, 33(11), 1161-1192. https://doi.org/10.1017/S1041610221000119
- Zhao, W., Jones, C., Wu, M.-L. W., & Moyle, W. (2022). Healthcare professionals' dementia knowledge and attitudes towards dementia care and family carers' perceptions of dementia care in China: An integrative review. Journal of Clinical Nursing, 31(13-14), 1753-1775.