It has been argued that a more person-centred pathway in acute hospital services, where bio-psychosocial needs are in focus for care of older patients with cognitive impairment, improve outcomes for patients, family members and staff [1, 2]. However, acute hospital services commonly have a strong medical focus built on medical routines and organisational efficiency; something which may contrast with the person-centred care (PCC) philosophy that aims to incorporate psychosocial needs as much as medical needs especially in relation to older patients and the specific needs that accompany a cognitive impairment [1, 3, 4]. The limited holistic perspective that is implied in disease-centred, not person-centred, care for older patients and their needs has been linked to several complications during hospitalisations such as pressure sores, incontinence, falls , malnutrition [6, 7], functional decline , delirium [9, 10], longer hospital stays and increased mortality .
The contemporary business model of health service provision prioritises attending to medical needs and discharging patients as soon as their medical condition is stable, which risks giving patients’ biopsychosocial needs lower priority, which may result in dissatisfaction with care [1, 4, 12]. It has been shown that disease-oriented and efficiency-driven ward structures work against the provision of PCC . Barriers to PCC provision can also be found in having a busy and strongly medicalised environment and in a lack of staff consensus about models of care for older patients with cognitive impairment . Acute hospital services that contain such barriers risk failing to meet the biopsychosocial needs of older patients , and risk missing out on economic and personal benefits such as lower costs and higher staff and patient satisfaction that have been linked to increasing hospital person-centeredness [14–17].
To increase the quality and safety of acute hospital-based health services to the ageing population, there is a need to explore further and compare the extent to which acute hospital services provided to older patients are perceived as being person-centred in relation to the needs that accompany ageing and cognitive decline [18–20]. To enable such explorations and comparisons, we need valid, reliable tools that provide comparable data on levels of perceived person-centeredness in various services. To date, however, tools that enable valid and reliable measurements for national and international comparisons are lacking. Developing measurements further is required, as person-centeredness is considered to be an indicator of contemporary high quality health services of older people with cognitive impairment [11, 19].
Reporting valid and reliable tools for this purpose makes possible the accumulation of internationally comparable data on the extent to which acute hospital health services are person-centred in relation to older patients with cognitive impairment. A recent review identified 12 eligible tools for measuring PCC internationally, where only three were adequate for use in acute hospital settings . However, none of the three tools were developed to measure PCC for older patients with cognitive impairment in the acute hospital environment.
To fill that gap in knowledge, the Person-Centred care of Older People with Cognitive impairment in Acute Care (POPAC) scale was developed to enable quantitative exploration of perceived levels of person-centeredness in acute settings and highlight areas in need of improvement. The scale was developed in an Australian version and tested in a sample of nursing staff at a metropolitan acute hospital in Melbourne, Australia, and was found valid and reliable . Further testing of the validity, reliability and applicability of the scale in other samples and settings was recommended, and permission was granted to use and test the POPAC in a Swedish acute care context. Thus, the aim of the present study was to translate POPAC to Swedish and evaluate its psychometric properties in a sample of acute hospital staff members in Sweden.