Junior doctor dementia champions in a district general hospital (innovative practice)

Wilkinson, Iain; Coates, Anna; Merrick, Sophie; Lee, Chooi

doi:10.1177/1471301215584083

Cited by 8 publications

(37 citation statements)

References 9 publications

(10 reference statements)

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“…Of the total 96 papers included at full text, 82 were included in EXPERIENCE OF HOSPITAL CARE FOR PEOPLE WITH DEMENTIA NIHR Journals Library www.journalslibrary.nihr.ac.uk review 1 [42][43][44][45][46][47] and 16 were included in review 2. 23,48,87,116,[133][134][135][136][137][138][139][140][141][142][143][144] Two papers 87,116 were included in both reviews 1 and 2.…”

Section: Study Selectionmentioning

confidence: 99%

“…Studies were conducted in six countries. Nine out of 14 studies (64%) were conducted in the UK, 23,48,116,133,134,138,139,141,143 two studies (14% each) were conducted in Canada 135,140 and Australia 136,144 and one study was conducted in Switzerland (7%). 137 All included papers were published in peer-reviewed journals.…”

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

“…One paper was published before 2010, 137 with the remaining 15 (94%) published after 2010. 23,48,87,116,[133][134][135][136][138][139][140][141][142][143][144] Seven studies 116,133,[138][139][140][141]143 reported the experiences of hospital staff, students and/or volunteers only; and seven studies 23,48,[134][135][136][137]144 reported the experiences of mixed types of participants. Together, studies reported the experiences of 83 people living with dementia, 62 carers and 213 hospital staff (see Appendix 9, Table 10, for a breakdown of roles), a total of 358 participants.…”

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

“…Interventions were conducted in a range of hospital settings, including general acute wards (n = 3), 138,140,141 dementia wards (n = 4), 23,133,135,137 geriatric acute wards (n = 3), 23,134,136 geriatric wards (n = 2) 116,139 and a rehabilitation ward (n = 1). 144 One study involved supporting junior doctors to become dementia champions while they were completing a rotation on a geriatric ward, a role they continued in during subsequent ward rotations, 143 and one study was conducted from an Alzheimer's Society stand in the hospital foyer. 48 Qualitative data were collected most often using semistructured interviews, with 10 studies 23,48,116,[134][135][136][137][138]141,144 drawing on this approach.…”

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

“…48 Qualitative data were collected most often using semistructured interviews, with 10 studies 23,48,116,[134][135][136][137][138]141,144 drawing on this approach. Seven studies 133,136,[138][139][140]143,144 held focus groups, and three studies 23,134,137 made use of observation. Seven studies combined methods, including a combination of interviews and observation; 23,134,137 interviews and focus groups; 136,138,144 and interviews, observation and focus groups.…”

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

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Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

Gwernan‐Jones

Lourida

Abbott

et al. 2020

Health Serv Deliv Res

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Background Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority. Objectives To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care. Review methods We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews. Data sources Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken. Results Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital. Limitations Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness. Conclusions The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required. Study registration This study is registered as PROSPERO CRD42018086013. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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Section: Study Selectionmentioning

confidence: 99%

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

Section: Review 2 (Experience Of Interventions)mentioning

confidence: 99%

See 3 more Smart Citations

Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

Gwernan‐Jones

Lourida

Abbott

et al. 2020

Health Serv Deliv Res

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New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change

et al. 2022

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Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based ‘pointers for service change’ to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to ‘get to know’, information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.

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The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study

et al. 2017

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Backgroundolder people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes.Methodsretrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI.Resultsof 19,269 admissions (13,652 patients), 19.8% had a DD, 11.6% had CI and 68.6% had neither. Admissions with CI or DD were older and had more females than those with no CI, and were more likely to be admitted through the Emergency Department (88.4% and 90.7%, versus 82.0%) and to medical wards (89.4% and 84.4%, versus 76.8%). Acuity levels at admission were similar between the groups. Patients with CI or DD had more admissions at ‘high risk’ from malnutrition than patients with no CI (28.0% and 33.7% versus 17.5%), and a higher risk of dying in hospital (11.8% [10.5–13.3] and 10.8% [9.8–11.9] versus (6.6% [6.2–7.0])).Conclusionsthe admission characteristics, mortality and length of stay of patients with CI resemble those of patients with diagnosed dementia. Whilst attention has been focussed on the need for additional support for people with dementia, patients with CI, which may include those with undiagnosed dementia or delirium, appear to have equally bad outcomes from hospitalisation.

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Junior doctor dementia champions in a district general hospital (innovative practice)

Cited by 8 publications

References 9 publications

Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change

The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study

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