Leeds Beckett University - City Campus,
Woodhouse Lane,
LS1 3HE
Dementia and Acute Hospitals
People with dementia are high users of hospital services, making it important that hospitals and their staff are well prepared to meet their needs.
Around a quarter of people in hospital in the UK have dementia and the most people with dementia have one or more co-morbid health problems, making them regular users of hospital outpatient services too. The range of care needs people living with dementia may have can mean that hospital staff and services sometimes struggle to meet their needs. We also know that outcomes of hospital care are less positive for people living with dementia than for similar groups of patients without dementia.
Our acute hospital-focused research responds to the need to improve experiences and outcomes of hospital care for people living with dementia and their families. Our research ranges from exploratory work to identify current care experiences and how these might be improved through to the development and evaluation of interventions to improve general hospital care (including inpatient and outpatient services) for people living with dementia. We use inclusive methods (such as the use of 'ethnography' - observing and spending time with people in hospital settings) to ensure the experiences and views of people with dementia are included in our research. We also work with NHS Trusts to share the findings of our research and develop ideas for improving care based on the findings.
Our portfolio of research in this area is predominantly funded by the National Institute for Health and Care Research (NIHR) but also by other funders such as the Alzheimer's Society.
Current and recent funded research and evaluation:
Around 90% of people with dementia have one or more other long-term conditions (such as heart disease, kidney disease or diabetes). They regularly use hospital outpatient services. The limited existing evidence suggests they experience many challenges when doing so, including difficulties accessing, understanding and making decisions about their care. No interventions have been developed to optimise outpatient care for PLWD and many aspects of existing inpatient-focused interventions are not applicable to outpatient settings.
This study aims to explore experiences of outpatient services for PLWD, families and staff, including examples of good practice and potential improvements and to co-design and feasibility test an intervention to improve outpatient care for PLWD and their families.
Chief Investigators: Dr Rachael Kelley and Professor Claire Surr
Leeds Beckett Investigators: Dr Nicky Taylor, Dr Andrew Papworth and Professor Anne-Marie Bagnall
Funder: National Institute for Health and Care Research (NIHR) Research for Patient Benefit Programme
Funding amount: £253,635
Hospital staff report difficulty using person-centred care during routine care activities despite increased access to training and resources. Managing patient safety, such as reducing a person's risk of harm from falls, is a priority for hospitals and staff. A common activity used to address risk of harm in people with dementia is constant observation. This involves allocating a member of staff to one patient, or a small group of patients, in one area of a hospital ward. The quality of care during this activity varies. This study mapped the use of constant observation for people with dementia and co-designed and tested the acceptability and feasibility of an intervention that supports person-centred care for people with dementia during constant observation.
Chief Investigator: Dr Melanie Handley, University of Hertfordshire
Leeds Beckett Investigators: Professor Claire Surr, Dr Nicky Taylor
Funder: Alzheimer's Society
Funding amount: £316,381
Study outputs: Handley et al (2023) The use of constant observation with people with dementia in hospitals: a mixed methods systematic review. Aging & Mental Health 27(12), 2305-2318. https://doi.org/10.1080/13607863.2023.2219632
The difficulties of being in hospital for some people living with dementia can mean they experience higher levels of distress, agitation, acute confusion and falls than other patient groups. Responses to this can vary and may include the use of ‘restrictive’ practices – responses that are designed to keep the person safe but can restrict the person’s movement or self-expression (such as the use of falls sensors, raised sides on beds, removal of walking aids, relocation of patients to side-rooms or supervised bays). At other times, alternative less-restrictive approaches may be used, such as engagement with activities, social interaction or attempts to identify and respond to unmet needs (such as pain or fear).
The use of ‘restrictive’ practices has been linked to adverse outcomes such as physical deterioration, increased distress and longer lengths of hospital stay. This study will use ethnographic methods (observations, conversations, interviews and documents) to explore the use, experiences and impacts of restrictive practices, and their alternatives, during hospital admissions for people with dementia. Data will be collected from, and with, people living with dementia, their families, and hospital staff. The study will focus on identifying strategies for supporting people with dementia who are distressed or at risk during a hospital admission in ways that are as unrestrictive and person-centred as possible.
Chief Investigator: Professor Katie Featherstone, University of West London
Leeds Beckett Investigators: Dr Rachael Kelley
Funder: National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research programme (HS&DR)
Funding amount: £1,053,221
People who have dementia often get distressed when they are in hospital. Distress can be shown by agitation, aggression or calling out. How healthcare practitioners say things can calm or inflame a difficult situation, but this has not been studied in detail in this setting. ‘Conversation Analysis’ is a research method which looks at the fine detail of the language we use, including ‘body language’, and the responses to it. This study has used conversation analysis to identify approaches that work in reducing distress in video recording of interactions between staff and patients with dementia in acute hospitals. It has developed a training programme on communication approaches to help prevent and support distress. This is currently being delivered to staff who work on two wards in each of in three acute hospital NHS Trusts. It is using in-depth case studies to assess the impact of the training on staff communication and patient and staff outcomes.
Chief Investigator: Prof Rowan Harwood, University of Nottingham
Leeds Beckett Investigators: Professor Claire Surr, Dr Andrew Papworth
Funder: National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research programme (HS&DR)
Funding amount: £828,827
This study aimed to describe the size, demographics and health resource use of the population of people with comorbid cancer and dementia and to understand their cancer care, treatment and support needs.
To read more about the study please visit the project page.
Chief Investigator: Professor Claire Surr
Leeds Beckett investigators: Dr Laura Ashley, Dr Rachael Kelley, Dr Alys Griffiths
Funder: National Institute for Health Research, Research for Patient Benefit Programme (NIHR RfPB)
Funding amount: £155,116
