Using occupation to support dementia and delirium care in hospital: An observational pilot study of a Task Box intervention

Introduction Approximately 90% of people with dementia and delirium experience behavioural and psychological symptoms of dementia (BPSD) during hospital stay. Occupational engagement and use of activity through a Task Box intervention may assist in reducing BPSD and the associated adverse events. Task Boxes consist of gradable occupation‐based activities implemented within person‐centred and Montessori approaches to provide cognitive and sensory stimulation by engaging preserved procedural memory. This study primarily aimed to evaluate staff and caregiver acceptability of Task Boxes to support occupational engagement for patients with cognitive impairment during a hospital admission. The secondary aim was to examine the impact of Task Boxes on patient adverse events associated with BPSD. Methods An observational mixed‐method pilot study implemented the Task Boxes on a geriatric acute and rehabilitation ward. This included initial staff training and weekly facilitation. Patients aged 65 or above with dementia, delirium or cognitive impairment engaged in Task Boxes in both group and individual settings. Staff and caregivers' acceptability was explored using a survey developed based on the theoretical framework of acceptability. Secondary outcomes included patient adverse events including falls and Code Blacks, which were extracted from patients' medical records and hospital clinical incident data and compared to historical ward data. Results Forty‐four patients, 22 staff and four caregivers participated. Eighty‐six per cent of patients engaged with the Task Boxes. Ninety‐five per cent ( n = 21) of staff and 100% ( n = 4) of caregivers accepted the Task Boxes. Eighty‐three per cent ( n = 18) of staff felt the Task Boxes improved their clinical skills. Over 85% ( n = 19) of staff and 75% ( n = 3) of caregivers agreed that the Task Boxes improved patient care. There was a 48% reduction in Code Black events on the ward during the intervention period. Conclusion Task Box use in hospital was feasible, supported by high acceptance by staff and caregivers. Pilot data showed a reduction in patient adverse events. A larger trial is warranted to explore the wider clinical benefits of the Task Boxes. Consumer and Community Involvement Healthcare staff and patients' families were consulted for the study set‐up. Their additional feedback has been reviewed in this research.