Inpatient psychiatric care for patients with dementia at four sites in the United Kingdom

Abstract

Psychiatric hospital beds for people with dementia are a limited resource. The number of people with dementia requiring inpatient psychiatric care is expected to increase as the population ages, but there is a striking lack of data informing these services. 1,2 We found almost no mention of inpatient mental health admissions in UK dementia policy or guidance. Previous literature suggests the main reasons for admission are neuropsychiatric symptoms which pose a risk of harm. 3 There is frequently a resistance to accepting care, tight legal frameworks which govern treatment and high levels of physical and psychiatric morbidity. The majority of published data is from audits of single wards or localities which means variability between units is unknown. 4,5 Our aim was to describe the clinical characteristics of patients admitted to inpatient dementia units, to establish their journey to and from the unit and describe workforce and clinical practice. | METHODSWe performed a multi-centre retrospective service evaluation, using routinely collected data from four diverse sites in the United Kingdom. Participating sites provided routinely collected service data for calendar years 2018 and 2019. This study was approved as a service evaluation. All data was anonymised at the patient level. | RESULTSResults are presented in Table 1. Three of the sites had one bed for every 200-250 people with a dementia diagnosis, though site 3 had less. Admissions averaged one per week per site. Alzheimer's disease was the most common diagnosis, followed by vascular dementia.Patients were predominantly male. Bed occupancy was high between 80% and 90%. Admissions were long with a mean duration of 100 days. There is a cohort on each ward who have longer admissions, one in six patients still remained in hospital after 6 months, and 2.5% had admissions of over 1-year duration. Most admissions were made using the Mental Health Act. Source of admission was commonly from acute hospitals or the patients' homes. Admissions levels only otherwise seen at the height of the coronavirus pandemic in the NHS. 9 Extra shifts were mostly to cover 1:1 observations, these were mostly covered through bank and agency unqualified staff, which might provide an argument for increasing staff establishment.In summary, we provide a study of nearly 500 admissions to psychiatric dementia inpatient beds and describe long lengths of stay, frequent placement in institutional care on discharge, high rates of falls and assaults and some heterogeneity of service provision. We found little previous literature on this topic and given the vulnerability and complexity of these patients suggest a larger and more detailed study to confirm these findings and inform the development of standards of optimal care.

Investigating the impact of music therapy on two in-patient psychiatric wards for people living with dementia: retrospective observational study

“…Incidents involving behaviours reported to be disruptive and aggressive were the most reported incidents on both wards during 2020, a problem that has been identified in studies looking at multiple NHS in-patient psychiatric wards for PwD. 5 The reduction in rates of distress behaviours on days with in-person music therapy shown here support other studies looking at the impact of group music therapy in in-patient psychiatric settings for PwD, which identify a positive impact on BPSD. [20][21][22]29,31 However, previous studies of music therapy in this setting have not examined the perception of staff and the impact on the ward environment.…”

“…4 However, the literature highlights the specialist nature of the work, caring for individuals who are unable to be safely cared for in other settings, with high rates of distress behaviours, termed 'disruptive and aggressive behaviour', on NHS wards. [5][6][7][8] Use of sedative medication, predominantly antipsychotics, is common, but these drugs are associated with a number of significant adverse effects, including decreased cognition and increased risk of falls, stroke and death. 5,9 This is accompanied by high rates of staff absence and use of agency staff.…”

“…[5][6][7][8] Use of sedative medication, predominantly antipsychotics, is common, but these drugs are associated with a number of significant adverse effects, including decreased cognition and increased risk of falls, stroke and death. 5,9 This is accompanied by high rates of staff absence and use of agency staff. 5 The impact on staff is important as research has long shown a close link between staff well-being, including job satisfaction and coping mechanisms, and patient well-being.…”

“… 5 , 9 This is accompanied by high rates of staff absence and use of agency staff. 5 The impact on staff is important as research has long shown a close link between staff well-being, including job satisfaction and coping mechanisms, and patient well-being. 10 , 11 However, very little research has investigated nonpharmacological interventions for this setting, despite calls for more research in this area.…”

Family experiences of inpatient mental health care for people with dementia

“…Further research is needed with a larger sample to reflect more wards from across the United Kingdom and also to reflect the range of different types of mental health ward that people with dementia might be admitted to (e.g., experiences of specialist dementia wards vs. mixed old age wards). The sample of people with dementia these carers supported were largely people with young onset dementia and some had rare forms of dementia, which may not be typical of the general population of people with dementia admitted to mental health wards (30). Further research is needed to engage with carers of older people with dementia and the expansion of recruitment methods beyond online methods may support this.…”