Research programme: Improving the quality and humanity of care for people with dementia in acute hospital wards
The focus
of our programme is the development of clinically relevant detailed
ethnographic research that identifies the needs of people with dementia, their
carers, and ward staff within in the acute setting. In 3 years, we have
established a track-record of leading interdisciplinary teams as PI and
obtaining research funding. Current grants obtained include the NIHR HS&DR Researcher-led stream
funded studies Investigating the
management of refusal of care in people with dementia admitted to hospital with
an acute condition (£447,000) and Understanding continence practices in acute
settings for people with dementia: raising awareness and improving care (£486,066.40) (in
submission). Both studies are hospital ethnographies that
involve long-term engagement within acute hospitals across England and Wales.
This work has a strong focus on improving the quality and humanity of care and
providing the empirical foundations for developing low-cost interventions and
training. The findings are already having an impact within NHS Trusts and our distinctive approach
demonstrates the utility and transferability of sociological theoretical
developments that respond to contemporary challenges within clinical settings.
Why do we need
research to examine the care of people with dementia in acute hospital wards?
There is increasing recognition that action is required now
to improve the experience and outcomes of people with dementia on admission to
acute hospitals for an unrelated condition (NICE and SCIE, 2006; NAO, 2007;
House of Commons, 2008; Department of Health, 2009; Health Foundation,2011).
Concerns persist about poor treatment, neglect, abuse, and discrimination of
older people in acute hospital (House of Lords, 2007; Francis report, 2013).
The Alzheimer’s Society’s most recent report (2016) identified widespread poor
dementia care, with wide variation in quality. This variation means that people
with dementia are ‘likely to experience poor care at some point along their
care pathway’ (Care Quality Commission, 2014).
People with dementia are one of the largest populations
cared for within the acute hospital setting, currently using up to one quarter
of acute hospital beds at any one time (Alzheimer’s Society, 2009). The
Department of Health corroborates these high rates (November 2014 in Alzheimer’s
Society 2016), finding that people with dementia occupy 25% of acute hospital
beds and account for around 3.2 million bed days per year. Still, informal
reports suggest this is a gross underestimate, with some acute hospitals
reporting that 40 to 50% of their patients have dementia (Alzheimer’s Society,
2016).
A diagnosis of dementia is associated with increased risk of
acute hospitalization (Phelan et al, 2012), with UTIs (Sampson et al, 2009),
pneumonia (Sampson et al, 2009), nutritional disorders (Pinkert and Holle,
2012), and hip fracture (Holmes, 1999; Pinkert and Holle, 2012) often being the
principal cause of admission.
People with dementia are a highly vulnerable group within
the acute hospital setting. Following an acute admission, the functional
abilities of people with dementia can deteriorate significantly (Goldberg et
al, 2012). A longitudinal cohort study of acute emergency admissions found that
patients over 70 with cognitive impairment had markedly higher, short-term
mortality with 24% dying during the acute hospital admission (Sampson et al,
2009).
In response, we use in-depth ethnographic approaches to
examine the work of nurses and healthcare assistants (HCAs) and other clinical
staff who are responsible for the care of people with dementia during their
admission within acute wards. Our goal is to provide the evidence base to
inform and improve the organisation and delivery of this care.
