Volume 57, May–June 2024, Pages 17-22Author links open overlay panel, , , , , , , , , , Highlights•

Behavioral interventions for behavioral and psychological symptoms of dementia are possible in acute care

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STAR-VA is applicable to acute care units with minimal modifications needed

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Behavioral interventions for behavioral and psychological symptoms of dementia increase staff efficacy and confidence responding to and managing distress behaviors in dementia

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Behavioral interventions on an acute care unit decrease behavioral rapid responses

Abstract

As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.

Section snippetsLong-term care behavioral interventions with veterans

Veterans are a subset of the older adult population with complex care needs. The older adult veteran population is predominately those who served during the Vietnam Era, who were exposed to toxins during their service, experienced high rates of traumatic brain injuries, have higher rates of substance use than the general population, and experienced significant traumas during their service.6 All of these factors often lead to more complex medical and mental health concerns and may increase the

Implementation framework

To guide implementation of STAR-VA, we utilized the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap. The roadmap consists of three phases: Preimplementation, Implementation, and Sustainment. Each area of implementation requires active participation of interested parties (i.e., clinicians, administrators, and leaders).16 In Preimplementation, it is necessary to identify system priorities, engage partners, and secure institutional commitment to implement the

Identifying system priorities / needs assessment

Out of 42 total nursing staff over half, 59.5% (n = 25) responded to the questionnaire. Of the respondents 84% were RNs, 4% LPNs, and 12% NAs. Forty percent had 10+ years of experience, 24% reported 6-10 years of experience, 24% had less than 3 years experience, and 12% had 3-5 years experience. 80% of staff self-reported taking care of a PLWD nearly daily and 76% of staff reported requiring emergent assistance to manage BPSD at least monthly. The biggest reported concern in caring for PLWD was

Discussion

Our quality improvement project aimed to implement a behavioral management program for veterans with BPSD on an acute care unit. A staff needs assessment indicated nurses felt they lacked necessary skills for working with veteran's with BPSD and noted an increase in delayed discharges due to BPSD. These findings are consistent with past literature that suggests acute care staff are often less equipped to manage patients with dementia and/or BPSD.11,12 Past research demonstrates the significant

Conclusion

Overall, our project demonstrated that the STAR-VA intervention was efficacious on an acute care unit, suggesting that this may be an effective intervention in other acute care units in this hospital. Over the course of the implementation period there was a decrease use of emergent calls for veterans with BPSD who were part of the STAR-VA program. Adaptations were made to the STAR-VA protocol to match the setting of acute care; however, these adaptations were minor and did not change the core

CRediT authorship contribution statement

Hannah M. Bashian: Writing – review & editing, Writing – original draft, Supervision, Methodology, Investigation, Conceptualization. Julia T. Boyle: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization. Seneca Correa: Writing – review & editing, Writing – original draft, Investigation, Conceptualization. Jane Driver: Writing – review & editing, Validation, Supervision, Resources. Caroline Madrigal: Writing – review & editing,

Declaration of competing interest

None

Acknowledgements

This work could not have been completed without the support of individuals and programs within VA Boston Healthcare System. We would like to thank nurse managers, Entela Izzo, MSN, RN and Yafet Abadi, BSN, RN, PharmD; medical scheduling assistant, Cathleen Conran; Medical Director of the Consult-Liaison Psychiatry Service, Dr. Larkin Kao; and Training Director of the VA Boston Psychology Fellowship Program, Dr. Amy Silberbogan. More broadly, we would like to thank VA Boston Nursing Leadership,

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