For those people with confusion in hospital a positive outcome following the admission is no different to anyone else.
When, in a recent survey, we asked people who had been confused during a hospital admission (whether due to living with dementia, or an episode of delirium) and their family and friends what they would consider a positive outcome from a hospital admission their views were no different to those of anyone else going into hospital - there is a desire to be able to return home to the daily life they lived prior to admission with the same level of functionality and capacity.
In order to achieve this outcome the survey highlighted a number of areas that respondents saw as important, such as improved care, enhanced understanding of dementia by staff, better communication, greater involvement of family and carers during the admission and a focus on a dementia enabled and supportive environment within the hospital setting.
A key finding from the survey was the need for those who have a caring role to continue to be consulted and involved in the care that person receives during a hospital admission on an equal footing to the professionals within the hospital. A focus on involvement and continuous communication with carers and family throughout the admission was emphasised as important and respondents reported several examples of miscommunication or lack of communication:
“The person’s family are the people who know the person the best so therefore can be useful to the medical staff for information”
“Dieticians ordering yoghurt when the person does not like this, and no attempt to ask visiting family”.
A common theme from respondents, especially reported by family carers, is a lack of focus on rehabilitation to improve the chances of the person returning to the level of mobility and functionality they enjoyed prior to admission:
“they are disabled by lack of rehab”
“I felt the rehab was almost invisible”
“I felt there was just an expectation that none of this would be possible so why try?”
Another common thread in the responses around care and treatment related to a lack of focus on drinking and eating while in hospital:
“he was left on 2 occasions with no nutrition and no medication for 2 days”
“I felt it was my job to ensure she drank each visit and would encourage her to have at least one, sometimes 2 cartons”.
From the survey it came through that, even with the focus we have had on dementia over recent years, several respondents commented on the lack of understanding and appreciation of dementia by the care staff within the hospital:
“staff need to be aware that there is different levels of dementia and patients may present well”
“what has happened to the nurses and doctors that they can’t see the person?”
“to have trained staff who understand dementia and how to communicate patiently and how to anticipate need”.
A number of respondents stressed the need to ensure the hospital environment is supportive and encourages treatment. This included providing the ability for carers to participate in the care, enabling wayfinding within the hospital and keeping the environment quiet and calm.
“She was a poor lost soul there, who had no idea where she was”
“quiet surroundings, private room”
“to have a family area to relax, to wait when personal care is carried out”
”visiting times that are not restricted”.
This study was part of a larger research project into “Understanding the outcomes of people with cognitive impairment and/or dementia admitted to the general hospital” .
The aim of this qualitative study was to explore what outcomes are the most important to people with confusion or cognitive spectrum disorders (CSD) in the general hospital. CSDs include cognitive impairment, dementia, and delirium.
A semi-structured online questionnaire was conducted from 11 April to 10 August 2017. Data was analysed according to a descriptive thematic analysis, and themes were discovered inductively with a focus on identifying negative and positive experiences and outcomes.
78 individuals completed the survey. Participants were predominantly carers or family members of a person living with dementia while experiencing an acute hospital admission (71) with the remaining (7) being people living with dementia who had experienced an acute hospital admission.
A detailed analysis of the survey will be published in the near future. For additional information please contact Henriette.firstname.lastname@example.org