Dementia

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It has been well documented that the ageing population is on the increase in Australia and due to these predictions so too is the demand on the acute care setting (Australia Institute of Health and Welfare [AIHW], 2007). Dementia is described as a "syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect memory, behaviour and ability to perform everyday activities" (World Health Organization [WHO], 2012, p.2).

Purpose:
The purpose of this literature review was to establish if the delivery of nursing care in the acute care setting, encompasses the older person with a Dementia diagnosis, using evidence based nursing interventions such as person centered care.

Background:
Though Dementia is not part of normal ageing (WHO, 2012) there is a high incidence of diagnosis in the older person. The ageing population will impact the demands of the health care setting, and health care workers require specialised skills to provide optimal care that is appropriate when an older person enters the acute care arena.

Method:
Initially the search question used for this review was can nurses identify triggers of exacerbated behaviour's using a validated tool? This question was omitted due to the lack of literature and refined to the broader context question of does nursing care of the person with dementia in the acute setting include evidence based practice, and how is person-centered care implemented. The data bases searched were from The Cochrane Library, CINAHL, pub Med, Joanna Briggs Institute and Grey Literature. The literature used in this review was published between 2003 and 2012. Literature sources were searched from peer reviewed journals, government publications, and the internet.

Keywords Searched:
Dementia, acute care, evidence based practice, nursing perspectives, behavioural and psychological symptoms of dementia, person centered care.

Results:
The literature review commonly noted that dementia care in the acute setting is lacking, and that further emphasis on adaption of knowledge translation related to evidence based practice is required. The common themes derived found that nursing staff in the acute care setting rationalized that "lack of time" to provide person centered care was the main reason for omission. Ward culture, experience and attitudes influenced clinical decision making of nursing staff in the acute setting, and the studies reviewed demonstrated that the needs of the nurse was prioritized over the person with dementia, thus person centered care is largely not provided in the acute setting (Bolster & Manias, 2010; Borbasi, Jones, Lockwood, & Emden, 2006; (Cowdell, 2010). If nurses were equipped with the experience to assist the person with dementia this would alleviate the acuity of the perceived workload of the nurse. This review however also revealed that nurses had a positive attitude to embrace evidenced based practice (Bolster & Manias, 2010). Implementation of the specialty needs of the person with dementia into the registered nurse graduate programs or on orientation to the acute ward setting using the "train the trainer model" (Alzheimers' Australia, 2011) would be beneficial.

Introduction
Due to the ageing population, current trends in Australia and globally, predict increasing care of the older person with dementia, estimating a dementia diagnosis will markedly increase in the next two decades (Department of Health and Ageing [DoHA], 2012). The prevalence of dementia in the older person is increasing and "...is estimated at 35.6 million worldwide and is projected to double every 20 years..with a new diagnosis every 4 seconds" (WHO, 2012, p.2). Older people are more likely to be admitted into the acute care setting (Edvardsson & Nay, 2011) so too are those with dementia (Cowdell, 2010), and the likelihood of complex needs will increase the risk of adverse affects for this populated group...
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