An aging populations mean increasing numbers of people with dementia in society. Cognitive impairment such as MCI (mild cognitive impairment) or even dementia are often seen in older people with the prevalence increasing with age up to 30–55 % in the group of patients aged 90–94 years.

It is supposed that beginning dementia and first syndromes presented by patients are often underrecognized [1, 2, 3, 4]. The incidence of around 250,000 cases annually is also increasing with age, i.e., compared with 2007, Beske [5] calculated for Germany increasing numbers of 51 % of people with dementia until 2030 and even 104 % until 2050.

Evidence shows that a significant proportion of general hospital inpatients have dementia. These patients tend to stay longer in the hospital than patients without dementia. For the patients, this often has an impact on previously existing or even newly emerging symptoms; for the hospital and the community, this often means an inevitable cost implication. In the general hospital setting, the current prevalence of patients showing dementia syndromes or suffering from dementia when admitted for other reasons is between 3.4 and 43.3 % [6]. Trauschke et al. [7] showed that in a geriatric ward, 50 % of the patients suffered from cognitive impairment up to dementia, with dementia recognized for the first time in 28.2 % of the patients. In a gerontopsychiatric setting, Hewer and Stark [8] described a high rate of patients not only suffering from dementia but also suffering from several nonpsychiatric comorbidities, thus, indicating interventional treatment was also needed. During hospitalizations, people with cognitive impairment are at high risk of developing major complications such as delirium in the perioperative as well as in the nonsurgical setting [9, 10, 11, 12, 13]. The ability of cognitively impaired persons to cope with stress situations, e.g., in-hospital treatment, is affected by staff behavior and the premorbid personality traits and both will influence mood and noncognitive symptoms [14].

In recent years, several good practice principles for care during the crucial setting “general hospital” were developed, including the wish to improve medical treatment for people with dementia and minimize risks of developing major complications of illness (e.g., falls, delirium, pressure scores, and incontinence):

  • special care units [15, 16, 17],

  • conceptual training of staff responsible for the care of people with dementia in hospitals [18] in order to improve awareness,

  • consultation–liaison psychiatry support by multiprofessional teams [19],

  • perioperative delirium prevention programs including co-operative medical and psychological interventions by trained staff [20, 21], and

  • special emergency department processes [22].

Most of the strategies focus on nonpharmacological interventions such as specially designed ward settings and multicomponent interventions and tailored training solutions for the caregivers [23, 24, 25].

When attempts are made to apply adequate hospital care in people with dementia, many of these multimodal approaches closely resemble interventions already well-established in care homes, e.g., communication training of staff [26, 27, 28, 29, 30], taking architectural and environmental requirements into consideration [31], offering geriatric consultant services [32], and varied nondrug therapies [33].

The “People with dementia in general hospital” project

Since 2006, the Alzheimer’s Society of Lower Saxony, Germany, has been focusing on the problem that adequate care and medical treatment for people with dementia in general hospital is different than that for people without dementia and outcomes are poorer.

Originally founded during a conference of experts in that field, an interdisciplinary team systematically worked on the topic for several years and presented results at various symposia. In 2011 a two-stage curriculum was completed. In combination with a training manual, the curriculum was sent to all hospitals and nursing training colleges in Lower Saxony, Germany. Furthermore, all training materials can easily be downloaded from the Alzheimer’s Society of Lower Saxony homepage [34].

The curriculum at stage one (basic education, 14 h training) addresses all people involved in the hospital treatment of patients with dementia. At stage two, advanced training is offered for specialized staff members such as trainers and dementia appointees/chaperones (160 h training).

Basic education

The aim of the basic education, which includes 14 h of training, is to reach hospital staff members at all levels in order to

  • provide information, basic knowledge, and basic competence in dealing with and getting in contact with patients suffering from dementia. Special ways of communication as well as recommendations for action with these patients are presented. As a consequence, everyday work in a hospital with demented people shall be facilitated,

  • establish more open involvement and communication with families, and

  • improve the medical treatment situation of patients suffering from cognitive impairment, resulting in better outcome.

An overview on educational objectives and time requirements for basic education is shown in Tab. 1.

Tab. 1 Basic education (14 h training; [34])
Full size table

Trainer education

The 160-h curriculum established for trainers and specialized staff members concentrates on extensive expertise and qualification. Moreover, graduates shall be able to

  • develop and implement special concepts to improve the medical treatment situation of people with dementia in their general hospital,

  • offer the “basic education” module of this curriculum to other staff members of their hospital, and

  • develop and implement guidelines for quality assurance in their hospital.

An overview on educational objectives and time requirements for trainer education is presented in Tab. 2.

Tab. 2 Trainer education (160 h training; [34])
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Training manual

The training manual presents several other projects implemented on that field (“good practice” with examples from throughout Germany) with a short overview about background and facts of the projects and data on accommodation addresses and contact persons.

In addition, the folder includes a list of 13 recommendations for “dealing with demented people in a general hospital” that can also be presented as a poster in several hospital work areas (e.g., peripheral ward, operating room, emergency room).

The manual also includes an information sheet from the German Alzheimer’s Society on what aspects require special attention when a demented person is admitted to a hospital (knowing that hospital environments can be disorientating and frightening for a person with dementia and may make them even more confused than usual) and a list of established speakers in the field.

The training manual also includes a 30-min film. After a well-structured introduction in the area “Dementia and delirium” special recommendations are presented with regard to typical dementia diagnosis-related problems such as moving and walking about, challenging behavior, ensuring adequate nutrition, etc. Finally, in the film some “good practice” examples are also presented—interviews with those members of staff responsible for the implementation and continuation of the projects are conducted and different concepts of the hospitals are presented.

Conclusion and outlook

The aim of the introduced curriculum “Caring for people with dementia in general hospitals” was to improve the situation of demented patients by making the implementation of proposed measures possible as a low-threshold opportunity for many hospitals.

After having sent the training manual to hospitals and nursing colleges in Lower Saxony, the feedback was overwhelmingly positive. In 2012, the project won the “Preis für Engagement und Selbsthilfe” of the Hertie Foundation and the “Niedersächsischen Gesundheitspreis” awarded by the Lower Saxon Ministry for Social, Women, Family, and Health Affairs.

Currently, in cooperation with the German Alzheimer’s Society, the distribution of the concept throughout Germany is being discussed, including further opportunities to encourage and facilitate the implementation of such strategies in the future.