Introducing the ‘3 Fs model of complexity’ for people with dementia accessing a NHS mental health inpatient dementia assessment ward: An interpretive description study

Abstract

Background In the United Kingdom, the use of the terms ‘complex’ and ‘complexity’ alongside dementia is reflected in a number of policy and practice documents. However, there is a lack of evidence that explores how complexity is perceived, constructed and experienced by people with dementia, family carers and practitioners working in the NHS dementia inpatient assessment wards [dementia assessment wards]. Objective To explore the meaning and concept of complexity in dementia from within the setting of a dementia assessment ward and develop a practice model. Methods The study was conducted over three phases: 1) an online electronic survey of UK national dementia leaders; 2) individual interviews and a focus group with dementia practitioners in two dementia assessment wards; 3) case studies of four patients with dementia resident on a dementia assessment ward which included their identified family carer/consultee, the named clinician on the ward involved in that person’s care and a care records review. Results The findings highlighted that complexity is constructed through a number of interconnected and interrelated domains that vary in acuity. These findings have been developed into the ‘3 Fs Model of Complexity’ and the 3‘Fs’ stand for Fixed, Flexible and Fluctuating. The Fixed domain consists of six components which are always present in complexity. The Flexible domain consists of 14 components and a person with dementia may experience any number of Flexible domain components at any one time. The Fluctuating domain highlights that all components have the ability to vary in their acuity. Conclusion The ‘3 Fs Model of Complexity’ may facilitate a more holistic view of a person with dementia than when ‘symptoms’ are viewed in isolation. Going forward, and subject to further refinement and testing, the ‘3 Fs Model of Complexity’ could help guide the selection of tailored, personalised interventions for people with dementia, including formulation approaches.

What matters most: Exploring the everyday lives of people with dementia

“…The study also shows how individuals with dementia actively shape and interpret their daily realities while confronting the disruptive effects of its lived experience, with the person often pushing against its boundaries and deleterious impacts 18,40 . These intertwined and complex experiences of people with dementia need to be acknowledged and seen to challenge the ‘living well’ narrative that currently permeates the dementia studies and care fields 37–39 …”

“…18,40 These intertwined and complex experiences of people with dementia need to be acknowledged and seen to challenge the 'living well' narrative that currently permeates the dementia studies and care fields. [37][38][39] New insights that supplement the scoping review 16 include the significance of place and objects for a sense of belonging and connection to self across past, current, and future time. The experience of future uncertainty, living in the present, and anchoring oneself in the past to maintain self is in line with research on lived time.…”

“…46,47 Moreover, it increases susceptibility to physiological and emotional regulation challenges when facing daily stressors. 48 Jones et al 37 also highlight that the presentation of complexity in dementia is influenced by re-experiencing past life traumas. As the prevalence of adverse childhood experiences in older adults is over 56%, 49 more attention is needed to understand how past traumas and life experiences may impact individuals with dementia in their everyday lives.…”

“…Moreover, it increases susceptibility to physiological and emotional regulation challenges when facing daily stressors 48 . Jones et al 37 . also highlight that the presentation of complexity in dementia is influenced by re‐experiencing past life traumas.…”

Complexity and practice on NHS mental health in-patient dementia assessment wards

“…Staff on a dementia assessment ward are multi-disciplinary but mental health nurses (MHNs) and Health Care Support Workers constitute the largest percentage of staff working on these environments (Edmans et al , 2022; Jones, 2019). In a summary of nearly 500 admissions to dementia assessment wards at four sites in the UK, Edmans et al (2022) described long lengths of stay, frequent placement in institutional care on discharge, high rates of falls, assaults (including ward staff) and some heterogeneity of service provision.…”