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; (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
Published inBMJ Open
MetadataShow full item record
Showing items related by title, author, creator and subject.
A Case Study of Co-production Within a Mental Health Recovery College Dementia Course: Perspectives of A Person With Dementia, Their Family Supporter and Mental Health Staff West, Juniper; Birt, Linda; Wilson, Danielle; Mathie, Elspeth; Poland, Fiona (2022-06-22)Background: Undertaking co-production as a power-sharing way to improve mental health dementia services remains uncommon, suggesting opportunities to apply knowledge from lived experience of people with dementia, may often ...
Case study: Destination readiness for dementia-friendly visitor experiences: A scoping study : Destination readiness for dementia-friendly visitor experiences: A scoping study Connell, Joanne; Page, Stephen J. (2019-02-01)Ageing and dementia are major societal challenges affecting many countries, with around 46.8 million people worldwide estimated to be living with dementia. These estimates suggest that the worldwide population of people ...
Darlington, Nicole; Arthur , Antony; Woodward , Michael; Buckner , Stefanie; Killett, Anne; Lafortune, Louise; Mathie, Elspeth; Mayrhofer, Andrea; Thurman , John; Goodman, Claire (2020-10-08)Dementia Friendly Communities (DFCs) are one way in which people living with dementia can be supported to be active, engaged and valued citizens. Quantitative evaluations of the experiences of those with dementia living ...