Title: Improving the acute hospital care experience from admission through to discharge for older patients with cognitive impairment and their carers / families.
Funder: Health Education England

Abstract: Background: Out of all older people in general hospitals, approximately 31% will have dementia and 20% will have delirium. Despite the number of older people in hospitals with cognitive impairment, little research has focused on their care and none has considered patient and carer perspectives across the whole of the pathway from admission through to discharge. A number of initiatives have taken place in recent years in response to the National Dementia Care Strategy and the National Audit of Dementia Care in General Hospitals, all with the aim of improving hospital dementia care e.g. the RCN SPACE Principles Framework, Royal College of Psychiatrists Charter Mark, however no comprehensive toolkit for Trusts exists, to enable and support staff to ensure the best possible care experience for older patients with cognitive impairment across the whole of the general hospital care pathway.Aims: The aim of this research is to improve the care experience of older patients with cognitive impairment and their carers / families, whilst in acute hospitals by developing a toolkit for Trusts. Research questions: Research questions are: What factors contribute to a positive patient experience and also a negative experience for older people with cognitive impairment (dementia and/or delirium) admitted to acute hospitals? What factors contribute to positive and negative carer/family experiences during this time? How can staff be enabled and supported to ensure the best possible care experience for older patients with cognitive impairment and their carers/families throughout the patient pathway? Plan of investigation: There will be three separate but linked work streams (WS1-WS3), following MRC Guidance on the Development and Evaluation of Complex Interventions: WS1: Systematic and policy review of best practice in the care of older people with cognitive impairment (in acute hospitals and also other settings such as care homes) WS2: Qualitative social constructionist study in a local NHS acute Trust, using case study methodology, to determine the factors that contribute to a positive patient experience and also a negative experience for older people with cognitive impairment and their carers/families WS3: Development, piloting and service evaluation of a toolkit for use by Trusts to ensure the best possible experience for older patients with cognitive impairment and their carers/families. Robust and effective collaboration with two bespoke involvement groups (Consumer Reference Group and Expert Reference Group) will be an integral part of the research throughout all three workstreams. Summary of potential benefits to patients and NHS: The main benefit of this research will be the development of a toolkit which will enable and support staff in NHS general hospital Trusts, at all levels, to provide the best possible care for older patients with cognitive impairment and their carers/families. This will be based on a systematic review of the literature, the findings of a qualitative study incorporating patient, carer/family and staff perspectives and will be informed by robust and effective involvement of a local consumer reference group and a national expert reference group. The research will also provide novel, empirical, in depth research on the experiences of people with dementia in acute hospitals to complement the recent National Audit of Dementia in General Hospitals, the latter taking a quantitative approach.

Lay abstract: The aim of this research is to improve the care experience of older patients with cognitive impairment and their carers/families whilst in acute hospitals. This will be achieved by:1) reviewing the literature on best practice in care of older people with cognitive impairment, 2) a qualitative study looking in depth at several cases in a local hospital to find out what contributes to a positive and a negative patient experience, 3) developing and evaluating a toolkit for use by acute Trusts 4) active participation of two bespoke involvement groups throughout the study (Consumer Reference Group and Expert Reference Group).

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: NEUROLOGICAL