Wednesday, 3 May 2017

Research Programme Background

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.
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