Background: It is challenging for care teams to learn about hospitalized older adults with Alzheimer’s Disease and other related dementias (ADRD). Life stories – interventions that collect patient’s personal narratives, histories, likes and dislikes and share them with care teams – are one innovation developed to enhance person-centered care. Few studies have explored the implementation of Life Stories in the acute care setting. This study aimed to assess the acceptability and feasibility of a Life Story intervention in an acute care hospital setting.
Methods: The study took place on an Acute Care for Elders (ACE) unit at an academic medical center. With key informants, we adapted an existing Life Story intervention for long-term care, tailoring it to the hospital setting. Eligible Life Story participants were ≥65 years old, English-speaking, and had a pre-admission diagnosis of ADRD or positive screening for risk of acquiring hospital delirium. Caregivers of participants were also eligible. Figure 1 summarizes Life Story data collection and dissemination. Life Stories were uploaded to the Advance Care Planning section of the electronic health record (EHR) and emailed to patients’ care teams. Patients, caregivers and clinicians were interviewed about their experiences of the intervention. Interviews were transcribed and analyzed using inductive thematic analysis.
Results: Of 95 eligible patients, 20 Life Stories were captured and incorporated into the EHR (21% completion rate). Reasons for declining to participate were inability to contact a caregiver, acuity of the patient’s illness, or insufficient caregiver time due to the patient’s hospitalization.One story was incorporated into the EHR while the patient was hospitalized, and 19 were incorporated after patient discharge. Stories were incorporated post-discharge due to challenges scheduling a life story interview during the patient’s hospitalization. Interview data identified four common themes among patients, caregivers and clinicians about the intervention: 1) Generated therapeutic impact; 2) Facilitated connections between clinicians and patients; 3) Supported compassionate clinical care; 4) Promoted clinician’s enjoyment in their work (Figure 2). Clinicians were highly supportive of the intervention but anticipated that time constraints would impact their ability to consistently read the Life Story. There was no consensus on the optimal EHR location of a life story.
Conclusions: There was widespread acceptability of a Life Story intervention, with patients, caregivers and clinicians noting its potential to support patient-centered care. However, there were significant timing and feasibility challenges to implementing this intervention during hospitalization. Future iterations could trial Life Story collection in the outpatient setting and then determine optimal workflows for promoting access by hospital clinicians.
