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P14. Care services: Acute and hospital care

Detailed programme, abstracts and presentations

P14.1. The needs of patients with dementia in acute hospital wards: Patients’ perspectives and observed practices

SCERRI Anthony1, INNES Anthea2, SCERRI Charles1

1University of Malta, Msida, Malta, 2University of Salford, Salford, United Kingdom

Background: There is an acknowledgement that the needs of persons with dementia admitted in acute hospitals are not always met. Previous studies have focused on the perceived needs of professional caregivers or family members whilst the voices of patients with dementia in acute hospitals have not been extensively reported. This may have contributed to the under-recognition of the needs of persons with dementia.

Objectives: The aim of this study was to understand the needs of persons with dementia in acute hospitals and whether they are being or have been met, as perceived by the patients themselves and their family caregivers and by what has been observed in practice.

Method: Thirteen patients with dementia in three acute wards who could verbally communicate with the researcher, were purposively selected. Semi-structured interviews were conducted to elicit the patient’s experiences of their hospital stay and whether their needs are being/have been met. Moreover, routine care with the same patients was observed using Dementia Care Mapping the Hierarchy Model of Needs in Dementia (Schölzel-Dorenbos, Meeuwsen & Rikkert, 2010), was used as a framework to categorise these needs.

Findings: Patient report and observational data demonstrated that basic needs such as toileting, feeding, drinking, managing pain and comfort were not always met. Moreover, the largest gap between met and unmet needs was related to ‘being’ needs especially being free to take decisions. Too much emphasis was perceived and observed to be given by staff on safety needs at the expense of other needs. The patients’ need for social contact and self-esteem needs were often ignored and led them to feel devalued.

Conclusion: Staff need to be more aware of the holistic needs of patients with dementia in acute settings and the way how to deliver care to balance these needs to ensure that they provide person-centred care.

P14.2. The care of people living with dementia in acute hospital wards: results from an ethnographic study

FEATHERSTONE Katie1, NORTHCOTT Andy2

1Cardiff University, Cardiff, United Kingdom, 2De Montfort University, Leicester, United Kingdom

There is increasing recognition that action is required now to improve the experience and outcomes of people living with dementia on admission to acute hospitals for an unrelated condition. In the UK, concerns persist about poor treatment, neglect, abuse, and discrimination of older people in acute hospital, with widespread poor care identified. People living with dementia are one of the largest populations cared for within the acute hospital setting but also one of the most vulnerable. 

In response, this paper draws on the findings of 155 days of observational fieldworkin 10 wards within 5 hospitals across England and Wales (NIHR HS&DR researcher led funding), purposefully selected to represent a range of demographics, but allknown to admit large numbers of people living with dementia. These observations were accompanied by 436 ethnographic interviews and 10 detailed case studies conducted people living with dementia, observing their care at the bedside and speaking to the person and their family and carers throughout their admission.

We identified extremely high levels of resistance to care amongst people living with dementia within acute hospital wards. It was a common feature of ward life; every person living with dementia we observed admitted within the acute hospital ward resisted care during our period of observation. Importantly, resistance, in whatever form it manifested, was always interpreted by staff as a feature of the person’s dementia diagnosis that signified a lack of capacity, and as such a behaviour to be overcome or managed, rather than as a response to the care and setting itself. We show the emotional and somatic impacts of these approaches for people living with dementia and the ways in which a diagnosis of dementia becomes framed as risk within the ward that must be controlled and contained at the bedside. 

P14.3. Acute care for patients with cognitive impairment: a qualitative study

FOX Chris, CROSS Jane, HAMMOND Simon, POLAND Fiona, BACKHOUSE Tamara, PENHALE Bridget

UEA, Norwich, United Kingdom

Aging populations in developed countries worldwide place huge pressures on health services. Older age is a significant risk factor for falls, with hip-fracture being a serious consequence. The US and Northern Europe have particularly high rates of hip fractures, additionally multiple developing countries are likely to see increases over the coming decades as their populations age. Many older hip fracture patients also have some cognitive impairment. Such patients tend to have poorer outcomes compared to those cognitively able. 

As part of a large programme of study (PERFECTED) aiming to improve outcomes for older hip fracture patients with cognitive impairments, we used a qualitative approach to explore ideas for improving the care of these patients with hospital ward staff. A combination of focus groups and interviews were conducted with Trauma Ward Staff of differing seniority across three hospitals in England. An inductive approach was taken for data analysis.

Three overarching themes emerged from the data, these were: 1) the current context; 2) resource mismatch; 3) staff prioritising basic tasks. The findings showed instances of sub-optimal patient care and a lowering of staff morale and wellbeing where the stresses and strains of working on a trauma ward were reported.

Our findings show that some English trauma wards are struggling to cope with the increased proportion of patients with cognitive impairment. Through attending this session, participants will learn about the context of care in three acute trauma wards in England and how staff are working to optimise the care they deliver.

P14.4. What do physiotherapists need to know about dementia care? A focus group study

FOLEY Tony1, O'SULLIVAN Trish2, SHEEHAN Cormac1, JENNINGS Aisling1

1University College Cork, Cork, Ireland, 2Health Service Executive, HSE, Cork South Lee, Cork, Ireland

Background: In addition to cognitive decline, gait disturbance and impaired balance lead to a greater risk of falls and fractures for people with dementia. It is estimated that up to 40% of people who fracture their hip have dementia.  Furthermore, for people with dementia the recovery following hip fracture is complicated by the negative synergy of physical, psychological and social factors. Physiotherapists play a central role in dementia care.  However, there is a paucity of research from the perspective of physiotherapists that explores their role in dementia care or that identifies their dementia-specific educational needs.

Methods: A qualitative study was undertaken involving semi-structured focus group interviews with physiotherapists in order to gain a deeper understanding of their clinical experiences and educational needs around dementia care.  Six focus groups were undertaken with thirty-six physiotherapists.  Physiotherapists were recruited in County Cork, purposively sampled from both hospital and primary care settings.

Results: Physiotherapist participants described a large dementia-related workload.  The majority had not received any undergraduate or postgraduate dementia education and described working without appropriate clinical guidelines.  Participants found dementia care to be particularly complex because of limited time, perceived lack of knowledge, scarcity of resources and unclear care pathways.  Many expressed a wish to receive further dementia training and clear evidence-based guidelines.  They identified areas of educational needs including falls prevention, fracture rehabilitation, cognitive screening tools, communication techniques and the roles of other allied healthcare professionals.

Discussion: Our findings indicate that physiotherapists remain challenged by aspects of dementia care.  As dementia prevalence rises in line with ageing populations, the role of physiotherapists will become increasingly central in collaborative, multidisciplinary dementia care.  In order to meet the unique educational needs of physiotherapists, tailored dementia education should be developed and implemented, augmented by interprofessional education with other relevant healthcare professionals.

P14.5. Cognitive impairment / dementia in secure forensic psychiatric settings: a story untold

DI LORITO Claudio, DENING Tom, VÖLLM Birgit

University of Nottigham, Nottingham, United Kingdom

Introduction: Forensic psychiatric settings offer treatment to mentally-ill offenders who present an immediate risk of security to themselves and others. Older patients now represent 20% of residents in forensic psychiatric settings in several European countries, a proportion of whom may develop dementia. However, discourse around dementia in secure settings has been under addressed, potentially neglecting the needs of patients with the condition. We aimed to build evidence in this area, by undertaking research in three UK secure forensic psychiatric units.
 Methods: The project comprised two studies: Study 1 investigated the prevalence of cognitive impairment / dementia through administration of a cognitive assessment and access to patients’ clinical notes; study 2 gathered patients’ and professionals’ views around how secure services meet the needs of individuals with cognitive impairment / dementia, through administration of qualitative interviews.

Results: Forty-one patients were recruited for study 1, 27% scoring below the threshold for cognitive impairment. Formal diagnoses of dementia were virtually inexistent. Fifteen patients and 13 members of the staff were involved in study 2. The participants consistently reported lack of training / dementia awareness, a limited programme of age-friendly therapeutic / recreational activities, and a high risk of social isolation for the older patients.

Conclusion: Secure forensic psychiatric settings are still far from becoming dementia-friendly. In ensuring equal access to care and recovery opportunities to all patients and in preventing units from becoming dumping grounds for the most vulnerable ones, there is a need for service improvement. Given the limited resources of secure services, the expertise and support of local and national volunteer and third sector organisations can play a pivotal role in ensuring adequate provision. Good practice could be further promoted through the development of dedicated units for patients with intensive care needs and dedicated national policy for older offenders.

P14.6. What works in providing dementia education and training to health and social care staff? results from a UK study

SURR Claire1, OYEBODE Jan2, SMITH Sarah1, PARVEEN Sahdia2, CARA Sass1, DRURY Michelle2, BURNLEY Natasha1, CAPSTICK Andrea2, DENNISON Alison2, MEADS David1

1Leeds Beckett University, Leeds, United Kingdom, 2University of Bradford, Bradford, United Kingdom

Background: There is international recognition of the importance of an effective and knowledgeable dementia workforce. However, while in many nations the availability and uptake of dementia education and training has increased, the quality and impact of this is variable and poorly understood.

Aims: The aim of the UK-basedWhat Works?study, commissioned by the National Institute for Health Research Policy Research Programme, was to identify what constitutes effective dementia education and training for the health and social care workforce and the organisational conditions most likely to lead to positive impacts.

Methods: Methods used were: a systematic review of the dementia education and training literature; a national audit of current UK dementia education and training; a staff knowledge, attitudes and self-confidence survey; and ten in-depth case studies conducted in mental health services, acute care, general practice services and care homes. The case studies collected a wide range of qualitative, observational and quantitative data. An advisory group comprised of people with dementia and carers supported study design, methods, data interpretation and dissemination.

Results: Training that led to positive outcomes was delivered face-to-face, was interactive, tailored to the service setting and role of learners and delivered by an experienced training facilitator with clinical dementia experience. Barriers to training implementation including a lack of time and resources, poor staff attitudes towards training and poor planning in terms of release of staff to attend training. Facilitators included a supportive organisational culture and management, robust leadership for training and a whole systems approach connecting managers, trainers and learners.

Implications for policy/practice: Dementia training will form a component of any care quality improvement strategy. Care provider organisations, training providers, commissioners and policy makers should consider the training features and setting conditions that are more likely to lead to positive outcomes in training policy, design and implementation.

 

 
 

Last Updated: Tuesday 13 November 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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