17.07.17
How we can truly make a difference for inpatients with dementia?
Melanie Handley from the University of Hertfordshire outlines the findings of a new study that looked at the effectiveness of dementia care in hospitals, and what can be done to ensure better patient outcomes.
At any one time, 25% of hospital beds are used by people living with dementia, rising to a higher proportion on some wards. However, healthcare outcomes for people living with dementia are variable across the country and are inequitable when compared to outcomes for people without cognitive impairments.
It is well documented that inpatients with dementia are more likely to have adverse incidents, such as falls or poor nutrition, and have longer hospital stays than people with equivalent health needs who do not have dementia.
There is also increasing recognition that hospital staff and services need to understand the complexity of caring for and treating people living with dementia. The Alzheimer’s Society reported in 2016 only 2% of people living with dementia felt, in their experience, that all hospital staff understood their specific needs.
Because of this, the University of Hertfordshire was funded by the Alzheimer’s Society to review the effectiveness of dementia-friendly approaches and interventions for inpatients with dementia. Evidence was variable and to date there have been few evaluations, however we did discover some key principles that were likely to improve the patient experience.
Importantly, the review has highlighted the fundamental role that senior hospital staff play in championing changes to care provision and the limitations of some current approaches.
Supporting dementia awareness training
Dementia awareness training is important, but as a single strategy it will not improve dementia care in hospitals or outcomes for patients. The training needs to be a foundation on which skills can be developed with additional support from senior team members with expertise in dementia care.
By working closely with staff on the wards, senior staff can demonstrate how to apply the principles of good dementia care to patient care. This may also encourage staff to seek their advice around complex issues in care; for example, decisions around best interest.
Clarifying staff priorities for care
When staff are constrained by demands from other patients and the ward routine, it can be difficult to accommodate the needs of patients with dementia. We found staff considered some practices that supported good dementia care as additional, rather than integral, to their role.
Valuing time spent with patients with dementia, in order to provide quality care, should be encouraged by senior staff. To address the needs of patients with dementia effectively, staff roles and responsibilities may need to be modified in recognition of their reduced capacity to work with previous levels of patient allocation.
Endorsement by senior management
The majority of care for patients with dementia is provided by unqualified healthcare workers, who may not consider they have permission to provide care that draws on person-centred principles.
Findings from our review emphasised the importance of managers and senior clinicians promoting changes to practices that can improve how risk is managed. For example, training for healthcare workers from physiotherapists helped them to promote mobility in with frail, older patients outside of therapy sessions.
Where senior staff invested time in explaining how changes to care practices might benefit patients, this could motivate staff to approach risk differently. A number of studies reported how changes to wider hospital policies might further assist staff to feel they are supported to adopt the new care practices.
Recognising and addressing patient needs
Staff and management also need to better understand patient behaviour that is challenging as a communication of an unmet need.
Where this was understood, staff could individualise the care they provided to help maintain patient function (such as continence) and improve patient experience of care. If staff only address the behaviour by attempting to control or restrict it without understanding the cause, this has the potential to reduce patient mobility and increase their frustration and distress.
Next steps
There is more work to do that builds on some good initiatives. Ultimately, we hope that the findings from this study will help inform hospital management around how to support staff and to provide care that will lead to better outcomes for people living with dementia.
Staff have already received training through the national dementia training programme. The next step, and where this will truly make a difference, is for staff to have support from senior managers and access to clinical experts who can reinforce learning. Good dementia care requires a commitment to continued staff development to ensure that this is a priority area of care.
The Alzheimer’s Society hopes to achieve this through Dementia Action Alliance Dementia-Friendly Hospital Charter, which already has over 100 hospitals signed up.