Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review
Handley, Melanie; Bunn, Frances; Goodman, Claire
Citation: Handley , M , Bunn , F & Goodman , C 2017 , ' Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review ' BMJ Open , vol 7 , e015257 . DOI: 10.1136/bmjopen-2016-015257
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; (3) analysis and synthesis to build and refine the programme theory. Data sources: PubMed, CINAHL, Cochrane Library, NHS Evidence, Scopus, 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. Preoccupation with risk generated responses that were likely to restrict patient choice and increase their distress. Conclusions: This review suggests 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. PROSPERO Trial Registration Number: CRD42015017562
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
This item appears in the following Collection(s)
Showing items related by title, author, creator and subject.
Core Outcome Measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: systematic review and consensus recommendations Bunn, Frances; Goodman, Claire; Livingston, Gill (2017-06-29)Background There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of ...
Effectiveness of interventions to indirectly support food and drink intake in people with dementia : Eating and Drinking Well IN dementiA (EDWINA) systematic review Bunn, Diane K; Abdelhamid, Asmaa; Copley, Maddie; Cowap, Vicky; Dickinson, Angela; Howe, Amanda; Killett, Anne; Poland, Fiona; Potter, John F; Richardson, Kate; Smithard, David; Fox, Chris; Hooper, Lee (2016-05-04)BACKGROUND: Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to ...
The role of Dementia Champion in dementia care : Its aspirations, development and training needs (innovative practice) Mayrhofer, Andrea; Goodman, Claire; Smeeton, N.C. (2016-09-01)Background: The conceptualisation and development of the role of Dementia Champions in clinical practice is on-going, and dementia specific training has a significant impact on the scope of the role. Aim: This survey aimed ...
Your requested file is now available for download. You may start your download by selecting the following link: test