Case-finding for dementia during acute hospital admissions: a mixed methods study exploring the impacts on patient care after discharge and costs for the English National Health Service

Abstract

Objective: Between 2012 and 2017 dementia case-finding was routinely carried out on people aged 75 and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services. This study explored the impact of dementia case-finding on older people and their families and on their use of services. Design: Thematic content analysis was conducted on qualitative interview data and costs associated with service use were estimated. Measures included the Mini-Mental State Examination (MMSE), the EuroQol (EQ-5D-5L) quality of life scale and a modified Client Service Receipt Inventory (CSRI). Setting: Four counties in the East of England. Participants: People aged ≥75-years who had been identified by case-finding during an unplanned hospital admission as warranting further investigation of possible dementia and their family carers. Results: We carried out 28 interviews, including 19 joint patient-carer(s), 5 patient only and 4 family carer interviews. Most patients and carers were unaware that memory assessments had taken place, with many families not being informed or involved in the process. Participants had a variety of views on memory testing in hospital and had concerns about how hospitals carried out assessments and communicated results. Overall, case-finding did not lead to general practitioner (GP) follow up after discharge home or lead to referral for further investigation. Few services were initiated because of dementia case-finding in hospital. Conclusions: This study shows that dementia case-finding may not lead to increased GP follow up or service provision for patients after discharge from hospital. There is a need for a more evidence-based approach to the initiation of mandatory initiatives such as case-finding that inevitably consume stretched human and financial resources.