Interviewing people with dementia in hospital: recommendations for researchers

"I'm still in the lap of the gods… I don't know whether I'm going to improve or not": listening to people with dementia or cognitive impairment and their support people, talking about inpatient rehabilitation experiences

PURPOSE

People with dementia often experience poor outcomes in hospital and prolonged lengths of stay. They are sometimes labelled as having "poor rehabilitation potential". This study aimed to understand the inpatient rehabilitation experiences of people with dementia or cognitive impairment, and their support people, to inform future work to improve rehabilitation access and outcomes.

MATERIALS AND METHODS

An exploratory qualitative study from an interpretivist perspective. Participants were inpatients of a geriatric rehabilitation unit in Australia, and their chosen support people. Semi-structured interviews were audio-recorded and transcribed. An analytical framework was developed and indexed to the dataset, followed by charting and thematic analysis.

RESULTS

Ten people with dementia or cognitive impairment and nine support people participated (n = 19). Four themes were identified representing an interpretation of the analysis intended to inform clinical practice: Support patients to engage in the rehabilitation process; create a hospitable environment; recognise and work with care partners; and ensure staff have adequate dementia knowledge.

CONCLUSIONS

Practical, emotional, process-related, and dementia-specific factors may influence the experiences of people living with dementia or cognitive impairment when participating in inpatient rehabilitation. Future research could investigate whether improvements focused on these factors might enhance quality of care for people with dementia.

How do quantitative studies involving people with dementia report experiences of standardised data collection? A narrative synthesis of NIHR published studies

BACKGROUND

People with dementia are routinely included as research participants in trials and other quantitative studies in which they are invited to respond to standardised measures. This paper reviews the reporting of standardised data collection from people with dementia in reports published in the National Institute for Health and Care Research (NIHR) Journals Library. The aim was to understand how the administration of standardised, self-report measures with people with dementia is reported in NIHR monographs and what could be learnt from this about the feasibility and acceptability of data collection approaches for future studies.

METHODS

This was a systematic review with narrative synthesis. Broad search terms (Dementia OR Alzheimer*) were used to search the NIHR Journals Library website in December 2021. All studies that used (or intended to use) standardised measures to collect research data directly from people with dementia were eligible for inclusion. Information was extracted (where reported) on the process of data collection, dementia severity, levels of missing data and the experiences and reflections of those involved.

RESULTS

Searches returned 42 records, from which 17 reports were assessed as eligible for inclusion, containing 22 studies. Response rates from participants with dementia in these studies varied considerably and appeared to be related to dementia severity and place of residence. Little information was reported on the process of data collection or the reasons for missing data, and most studies did not report the experiences of participants or those administering the measures. However, there was an indication from two studies that standardised data collection could provoke emotional distress in some participants with dementia.

CONCLUSIONS

Through this review we identified both variation in levels of missing data and gaps in reporting which make it difficult to ascertain the reasons for this variation. We also identified potential risks to the well-being of participants with dementia which may be associated with the content of standardised measures and the context of data collection. Open reporting of and reflection upon data collection processes and the experiences of people involved is essential to ensure both the success of future data collection and the wellbeing of study participants.

TRIAL REGISTRATION

Registered with Research on Research https://ror-hub.org/study/2905/ .

Family involvement in euthanasia or Physician Assisted Suicide and dementia: A systematic review

OBJECTIVE

To assess how families are involved in situations of euthanasia or physician assisted suicide (PAS) in dementia.

DESIGN

Systematic review searching literature in nine databases from inception up to October 2021. We included studies on family involvement in euthanasia from the perspective of persons with dementia and family caregivers. Themes were formulated through thematic analysis. The design was registered at Prospero (CRD42022298215).

RESULTS

We assessed 215 of 4038 studies in full text; 19 met the inclusion criteria of which 13 empirical studies. Themes included for people with dementia: being a burden; stage of dementia, and permissibility of euthanasia/PAS. Themes for family were the burden of care, responsibility toward the euthanasia or PAS wish, permissibility of euthanasia/PAS.

CONCLUSION

The wish for euthanasia/PAS arises in situations of burdensome care and fear of future deterioration. The family feels entrusted with the responsibility to enact upon the death wish. In shaping this responsibility, four roles of family can be distinguished: carer, advocate, supporter, and performer. Family as in need of support themselves is understudied.

Collecting data on the experiences and perspectives of people with dementia in the acute care hospital setting: A systematic scoping review

BACKGROUND

People with dementia frequently experience poor health outcomes that require hospitalisation; however, the hospital setting is generally unsuitable for these patients. While it is well-recognised that understanding patient perspectives is crucial to providing person-centred care, current clinical care guidelines do not describe how to effectively collect feedback from people with dementia. Historically, people with dementia have generally been neglected from data collection exercises among practitioners and academic researchers, alike.

OBJECTIVE

The objective of this review is to describe the data collection processes from peer-reviewed evidence sources that include direct consultation with, and elicit feedback from, patients with dementia about their care experience in the hospital setting.

METHODS

The protocol for this systematic scoping review was pre-registered (https://doi.org/10.6084/m9.figshare.16614667.v1). The review considered primary quantitative and qualitative research involving people with dementia as research participants, regarding the quality of hospital care from the patient's perspective. Four databases were searched (MEDLINE, CINAHL Complete, APA PsycINFO and Embase), with 14 studies meeting the eligibility criteria.

RESULTS

There has been an increased interest in gaining the perspectives of people with dementia on their health care over the past 5 years. Sundry methodologies were employed by these studies, but most used informal qualitative interviews to support and enable participants with diverse symptoms and functional abilities to take part. Procedures concerning recruitment, ethics and consent, and data collection processes were, likewise, varied and not reported consistently across this body of evidence.

CONCLUSIONS

People with dementia can be meaningfully consulted as research participants in the hospital setting. Increased rigour when reporting the methodologies and strategies used during data collection is needed to provide guidance for health services and researchers to further enable the inclusion of people with dementia.

IMPLICATIONS FOR PRACTICE

Including people with dementia in data collection endeavours in the hospital setting is essential to improving health outcomes, increasing equity and providing better hospital service delivery to this vulnerable cohort.

Feasibility of conducting qualitative research with persons living with dementia and their caregivers during a home-delivered meals pilot trial

BACKGROUND

Among older adults, food insecurity is associated with poor health status and health outcomes; people living with dementia (PLWD) are at increased risk for insecurity. Approaches to addressing food insecurity among homebound older adults include two modes of home-delivered meals: (1) meals delivered daily to participants' homes by a volunteer or paid driver who socializes with the client or (2) frozen meals that are mailed to participants' homes. Research has not examined benefits of these meals for PLWD or their caregivers nor compared the effectiveness of these two approaches in reducing food insecurity. The objective of this study was to test the processes for recruiting and engaging in qualitative research with PLWD and caregivers in an effort to understand the context, implementation, and mechanisms of impact by which relationships between meal delivery and outcomes may be achieved in preparation for a larger, follow-on study.

METHODS

This is a qualitative sub-study of a pilot, multisite, two-arm pragmatic feasibility trial comparing the effect of two modes of meal delivery on nursing home placement among 243 PLWD. In this sub-study, we tested recruitment and enrollment procedures and piloted interview guides among a subset of participants and caregivers.

RESULTS

We recruited and conducted interviews with nine PLWD and seven caregivers. In testing the informed consent process, all participants were able to consent to be interviewed, and PLWD all demonstrated capacity to consent. We successfully used a cognitive screener to obtain scores of cognitive impairment for PLWD and observed scores indicating a broad range of function. Our interview guides successfully resulted in information about the context, implementation, and mechanisms of impact for meal delivery during the pilot.

CONCLUSIONS

In addition to establishing feasibility for the future trial, the substantive findings identified through the qualitative interviews provide an initial understanding of the contextual factors for meal delivery and the potential mechanisms of impact across meal delivery types that warrant further examination in a full-scale trial. Findings from our study provide crucial pilot data to support a follow-on trial to understand how to address food insecurity among PLWD.

NAME OF THE REGISTRY

ClinicalTrials.gov TRIAL REGISTRATION: NCT04850781 DATE OF REGISTRATION: April 20, 2021, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT04850781.

Patient navigation programs for people with dementia, their caregivers, and members of the care team: a scoping review

OBJECTIVE

The main objective of this review was to map the literature on the characteristics of patient navigation programs for people with dementia, their caregivers, and members of the care team across all settings. The secondary objective was to map the literature on the barriers and facilitators for implementing and delivering such patient navigation programs.

INTRODUCTION

People with dementia have individualized needs that change according to the stage of their condition. They often face fragmented and uncoordinated care when seeking support to address these needs. Patient navigation may be one way to help people with dementia access better care. Patient navigation is a model of care that aims to guide people through the health care system, matching their unmet needs to appropriate resources, services, and programs. Organizing the available information on this topic will present a clearer picture of how patient navigation programs work.

INCLUSION CRITERIA

This review focused on the characteristics of patient navigation programs for people living with dementia, their caregivers, and the members of the care team. It excluded programs not explicitly focused on dementia. It included patient navigation across all settings, delivered in all formats, and administered by all types of navigators if the programs aligned with this review's definition of patient navigation. This review excluded case management programs.

METHODS

This review was conducted in accordance with JBI methodology for scoping reviews. MEDLINE, CINAHL, APA PsycINFO, Embase, and ProQuest Nursing and Allied Health databases were searched for published full-text articles. A gray literature search was also conducted. Two independent reviewers screened articles for relevance against the inclusion criteria. The results are presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, and the extracted data are presented narratively and in tabular format.

RESULTS

Thirty-nine articles describing 20 programs were included in this review. The majority of these articles were published between 2015 and 2020, and based out of the United States. The types of sources included randomized controlled trials, quasi-experimental studies, and qualitative exploratory studies, among others. All programs provided some form of referral or linkage to other services or resources. Most dementia navigation programs included an interdisciplinary team, and most programs were community-based. There was no consistent patient navigator title or standard delivery method. Commonly reported barriers to implementing and delivering these programs were navigator burnout and a lack of coordination between stakeholders. Commonly reported facilitators were collaboration, communication, and formal partnerships between key stakeholders, as well as accessible and flexible program delivery models.

CONCLUSIONS

This review demonstrates variety and flexibility in the types of services patient navigation programs provided, as well as in the modes of service delivery and in navigator title. This information may be useful for individuals and organizations looking to implement their own programs in the future. It also provides a framework for future systematic reviews that seek to evaluate the effectiveness or efficacy of dementia navigation programs.

Through Thick and Thin: The Meaning of Dementia for the Intimacy of Ageing Couples

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from the perspective of an older couple's spousal relationship and related intimacy. This qualitative study explores the meanings of emotional and physical intimacy and the changes brought by dementia in the couplehood of persons with dementia and their spousal carers. The data comprise semi-structured interviews with 35 persons. The interviews were analysed using inductive qualitative content analysis. Four themes describing the meanings of relational intimacy were identified: intimacy as a striving force, intimacy turning into worrisome behaviour, intimacy as physical and emotional dependency, and intimacy turning into one-sided caring for a partner. Dementia changes the intimate relationship in many ways, but shared affection and long-term partnership help maintain the spousal relationship. While dementia may bring about conflicts and behavioural challenges in an intimate relationship, the couple's shared intimacy and a sense of responsibility for one another may serve as a resource and support the continuity of couplehood.

Fun and a meaningful routine: the experience of physical activity in people with dementia

Background

Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia.

Methods

The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied.

Results

The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out.

Conclusions

Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03149-6.

Using meta-ethnography to understand the care transition experience of people with dementia and their caregivers

Older adults living with dementia are at risk for more complex health care transitions than individuals without this condition, non-impaired individuals. Poor quality care transitions have resulted in a growing body of qualitative empirical literature that to date has not been synthesized. We conducted a systematic literature review by applying a meta-ethnography approach to answer the following question: How do older adults with dementia and/or their caregivers experience and perceive healthcare transition: Screening resulted in a total of 18 studies that met inclusion criteria. Our analysis revealed the following three categories associated with the health care transition: (1) Feelings associated with the healthcare transition; (2) processes associated with the healthcare transition; and (3) evaluating the quality of care associated with the health care transition. Each category is represented by several themes that together illustrate an interconnected and layered experience. The health care transition, often triggered by caregivers reaching a "tipping point," is manifested by a variety of feelings, while simultaneously caregivers report managing abrupt transition plans and maintaining vigilance over care being provided to their family member. Future practice and research opportunities should be more inclusive of persons with dementia and should establish ways of better supporting caregivers through needs assessments, addressing feelings of grief, ongoing communication with the care team, and integrating more personalized knowledge at points of transition.

Managing a Dual Diagnosis of Cancer and Dementia in an Acute Setting: Considerations, Implications, and Future Recommendations

OBJECTIVES

To present an overview of the issues related to the well-being of people affected by cancer and dementia. To highlight the evidence from dementia care that can help improve the care experiences of people with dementia and cancer.

DATA SOURCES

Electronic databases such as PubMed and CINAHL were used to retrieve relevant literature published between 2010 and 2020.

CONCLUSION

Having a dual diagnosis of dementia and cancer poses several challenges across the cancer care pathway. Communication, treatment decision-making, environment ,and time-related issues were all identified. The literature suggests the need for evidence-based guidelines taking into consideration the person and the environment to support this population.

IMPLICATIONS FOR NURSING PRACTICE

To address these challenges and offer an optimal care experience for this group and their families, solutions need to focus both on the workforce and the environment. Offering dementia education for professionals working in acute cancer care, as well as adapting local environments that facilitate people navigate the space can be a starting point to offer person-centered, rights-based dementia sensitive care.

"You're Part of Us and We're Happy to Have You Here": Practices of Social Inclusion for Persons with Dementia

Objectives: Practices of social inclusion are important for maintaining the relationships of persons with dementia and are associated with positive clinical outcomes. The objective of this study was to explore the in-action practices of social inclusion in the activity center of a community-based organization.Methods: This study applies an ethnographic approach - including participant observation, informal and semi-structured interviews - with persons with dementia (n = 31) and organization staff members (n = 9) to explore the in-action practices of social inclusion.Results: Seven in-action practices of inclusion were identified: ensuring time for individual relationships, building schedules centered around flexibility, empowering decision-making, normalizing dementia-related behaviors, involving family members, soliciting and integrating persons with dementia's feedback, and supporting persons with dementia to practice social inclusion.Conclusions: Care providers of individuals with dementia can effectively facilitate active connections with them by continually soliciting and incorporating their feedback, and by supporting persons with dementia to practice inclusion and care for others.Clinical Implications: Community-based organizations can be effective at supporting the active connection of individuals with dementia with others and should be promoted for individuals with mild to moderate dementia.

Persons with dementia as internet users: what are their needs? A qualitative study

AIMS AND OBJECTIVES

The aim of this study was to identify the needs and expectations of persons with dementia regarding dementia-related information on the internet concerning content, presentation, navigation, language and design.

BACKGROUND

Research on internet-related needs of persons with dementia is lacking. However, the importance of the internet as a source of health information is increasing. To improve health literacy and to ensure participation in therapy decisions, target group-specific health information is necessary, especially for persons with chronic conditions like dementia.

DESIGN

We conducted a qualitative interview study between April 2019 and April 2020 in the German-speaking part of Switzerland. To report the study, we used the COREQ checklist.

METHODS

We analysed the interview data using content analysis according to Mayring.

RESULTS

Four interviews with five persons with dementia took place. We identified two main themes: (1) 'use of media and changing needs' and (2) 'information about dementia on the internet'. The first theme is related to changing user habits due to progressing dementia. The second theme is focussed on requirements concerning design and content. Critical reception and assessment of internet-based information are also addressed.

CONCLUSIONS

Information should be adapted to the course of disease. Opportunities and positive aspects should also be mentioned. The presentation should be well-structured. Health professionals might support persons with dementia in searching and interpreting internet-based information.

RELEVANCE TO CLINICAL PRACTICE

Website operators should consider specific needs of persons with dementia regarding design and content. Involving persons with dementia in the development of website content and design could be an opportunity for better meeting their needs.

The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports

Introduction

Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire.

Method

In this cross-sectional study, persons with cognitive impairment ( n = 21) and their proxies ( n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p < 0.05.

Results

At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads.

Conclusion

The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.

'I used to be a gardener': Connecting aged care residents to gardening and to each other through communal garden sites

OBJECTIVE

To explore residential aged care facility (RACF) residents' use of communal garden sites as spaces for gardening and social connection.

METHODS

Phenomenological inquiry using semi-structured interviews with 13 residents, family members and staff of a rural RACF.

RESULTS

Interest, ability and willingness to engage in communal garden sites were evident but limited by multiple factors. Data highlighted the complexities of accessing gardens, gardening and other people. An enduring identity as a gardener provided a framework for maintaining a link between gardening, finding meaning and maintaining a sense of self.

CONCLUSION

Communal garden sites can improve quality of life and enable connectedness for RACF residents. However, a range of personal, attitudinal, institutional and resource-related challenges create barriers to gardening, and in the RACF isolation and inactivity persist. We conclude that these challenges might be overcome through provision of physical and emotional support for positive risk-taking, autonomy and access to the outside to continue gardening.

The experience of attending a farm-based day care service from the perspective of people with dementia: A qualitative study

People with dementia have different needs, and it is important to have variation in the services that are offered for this population. Farm-based day care aims to meet this diversity in need, but research on such services is lacking. The present study provides knowledge about how people with dementia experience attending farm-based day care services in Norway. Ten semi-structured interviews were conducted for five different services, while the participants were at the farm. The interviews were analysed in accordance with the content analysis of Graneheim, U., & Lundman, B. (2004) [Nurse Education Today, 24(2), 105-112] and revealed three main categories that included (1) social relations, (2) being occupied at the farm, and (3) individually tailored service. The findings were summarised in the overall theme that attending day care at a farm makes me feel like a real participant. Our findings indicate that the farm-based day cares in the present study provide person-centred care. The farm setting facilitates services that are tailored to the individual, where the participants get to use their remaining resources and spend time outdoors. Further, farm-based day care was described as being suitable for people with or without farm experience and must be seen as an important supplement to regular day care for those who could benefit from a more active service.

Habermas and the therapeutic function of language

The aim of this article was to interpret Habermas's concept of language in terms of its therapeutic potential which can be effectively realized in nursing practice. Drawing on Habermas's definition, we analyse the components of rational communication which are necessary for the patient and the therapist to achieve understanding. In doing this, we examine not only lifeworld, system and validity claims, which are well-known notions within Habermas's theory of communicative action, but also less frequently studied elements of this theory, such as everyday world, to which the patient refers in the process of self-understanding and identity construction. We also address culture and language as a pre-rational factor which can disturb, or even preclude, communication and understanding. In such circumstances, we propose supplementing the Habermasian therapeutic project with a psychoanalytical interpretations of the utterances of the patients who have difficulty defining the situation within which therapy is possible.

Exploring patient preferences for involvement in medication management in hospitals

AIM

The aim of this study was to identify patient preferences for involvement in medication management during hospitalization.

DESIGN

A qualitative descriptive study.

METHODS

This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis.

FINDINGS

Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication; (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen; only some were interested in taking more control; and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many.

CONCLUSION

There was significant diversity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge.

IMPACT STATEMENT

Little is known about patient preferences for participation in medication administration and hospital discharge planning. Individual patient understanding of and interest in participation in medication administration varies. In accordance with individual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.

Reflecting on the research encounter for people in the early stages of dementia: Lessons from an embedded qualitative study

Gathering meaningful data from people with dementia presents challenges to researchers involved in both qualitative and quantitative studies. Careful planning and implementation are required, including skilful and sympathetic management by the researcher who must pay attention to the cognitive challenges experienced by the person with dementia. These challenges are particularly evident when conducting structured interviews using standardised measures. This paper presents the findings of an embedded qualitative study undertaken within a pragmatic randomised controlled trial. The novel method involves nesting a qualitative analysis within a quantitative study by recording incidental conversation during structured interviews, requiring no additional data collection. The method shone a light on the formal interview process itself, something rarely revealed outside the interview setting. It provided a unique insight into the challenges posed by research participation for people in early-stage dementia. Analysis revealed three main themes relating to dementia as a condition and to the research design. First, people with dementia contributed very few conversational comments during the structured interviews. Second, the context of the interview, that is: managing the conversational interchange, responding to direct and often sensitive questions and making decisions about day-to day-feelings and experiences was difficult for participants to manage. Third, people in early stage dementia struggled with the content of the structured interviews due to their linguistic and cognitive demands. The findings raise questions about how people with dementia are included in research and the methods employed to gather accurate data with minimal inconvenience and stress for research participants.

Experiences of attending day care services designed for people with dementia - a qualitative study with individual interviews

OBJECTIVES

Day care is assumed to promote independence in home-dwelling people with dementia, increase well-being and enhance social stimulation. Few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees' experiences with day care designed for people with dementia.

METHOD

This study had a qualitative descriptive design and included individual interviews with 17 users attending day care. The analysis was undertaken using content analyses.

RESULTS

The participants reported that day care had a positive influence on their physical functioning, cognition, well-being, and situation at home because they were provided with social stimulation, meals, and activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care a safe place to be and enhanced a sense of belonging.

CONCLUSION

This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation, and enhances practical and cognitive functioning as experienced by the users. The staff has a major impact on the experience of the participants in the day care.

Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

OBJECTIVES

To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

DESIGN

A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

ELIGIBILITY CRITERIA

Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

RESULTS

Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context-mechanism-outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

CONCLUSIONS

This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

TRIAL REGISTRATION NUMBER

CRD42015017562.