- Around 70 percent of acute hospital beds are occupied by older people, a quarter of whom are living with dementia.
- Hospital care for people living with dementia exceeds £250,000,000 per year
- Patient outcomes are poor compared to people living without dementia, and difficult experiences are often reported by families
- In acute care people living with dementia have longer hospital stays, are more vulnerable to dehydration, falls and delays to discharge home
- Over 430,000 NHS staff have received foundation dementia awareness training
This Work Programme will develop the evidence base for dementia training in NHS hospitals. Viewing the acute hospital as a neighbourhood space increasingly occupied by people living with dementia, the research will examine the impact of dementia training on staff skills, knowledge, confidence and satisfaction, and improved outcomes for patients living with dementia in these settings. Quality and effectiveness of training programmes in acute hospital settings will be examined and their impact on length of hospital stay and readmissions for people living with dementia. Within a national context of standardisation of training programmes, recommendations from this work will promote dementia training design that impacts on improved patient outcomes, and which increase the knowledge and confidence of staff working with people living with dementia in NHS and other care settings.
A summary sheet of Work Programme 5 is available (please click here).
Aims across phases
Phase 1: Mapping the evidence
We will provide
- a systematic review of the current evidence base for dementia training in hospitals;
Through structured survey of hospitals in England and through staff surveys of a sample of hospitals we will:
- map the variation in dementia training currently provided to acute hospital staff in England; and
- assess the impact of differences in training and other dementia care related initiatives upon staff knowledge, confidence and satisfaction in interacting with patients with a diagnosis of dementia
Phase 2: Hospital Episode Data analysis
We aim to determine the types and elements of dementia training that are most strongly associated with changes in length of hospital stay (LOS), emergency readmissions (ERs), and mortality (death within 30 days of discharge) for older people.
In this phase we will
- measure the impact of dementia awareness training on length of stay, emergency readmissions, and mortality for patients aged 65 years and older.
- conduct a matched cohort study of the impact of dementia awareness training using data extracted from the Hospital Episode Statistics database and other relevant sources to collect data at the hospital level (e.g. ONS mortality data and Care Quality Commission data) which will be matched to Phase 1 data.
Phase 3: Multiple hospital case study
Using an organizational case study design we will further explore the implementation of training practices in hospitals. We will collect data from multiple sources (interviews, documents and training programmes, focus groups and surveys) and a range of stakeholders to build up a rich picture of change in context over time.
In this phase we will:
- review the content, implementation, and coverage of training in contrasting hospitals. We will also explore the acceptability and feasibility of the training to a range of hospital staff.
- identify the facilitators and barriers to the implementation and sustainability of dementia care training in hospitals.
- study the clinical and cost effective improvements for patients living with dementia and identify considerations for implementation of training in other settings.
- make recommendations for optimal dementia training and awareness raising in acute hospital settings.
Phase 4: Development of what constitutes an optimal package for dementia training in acute hospital settings and guidance on implementation
Dissemination of the recommendations will be an important part of this phase of work and will include both standard (e.g. publication, presentations at conferences) and innovative (e.g. Citizen Scientist web portals, on-line fora, links with 3rd sector organisations etc.) means of ensuring that the guidance is regionally, nationally and even internationally accessible.
- use the findings from Phases 1, 2 and 3, to provide recommendations about what constitutes an optimal package for dementia training/awareness raising in acute hospital settings.
- A draft set of recommendations will be the subject of focus groups of key stakeholders to determine a final set suitable for publication.
Phases 1 and 2 have recently been granted a favourable opinion by the Faculty of Health and Medicine Research Ethics Committee (FHMREC) at Lancaster University.
The WP5 Advisory Group Chair is Dawne Garrett, Professional Lead – Older People and Dementia, Royal College of Nursing. Our Member Involvement representative is Ann Johnson.
Group membership also includes Angela Rippon (CBE) Alzheimer’s Society Ambassador, Susan Davidson Age UK, Shaun Lever Dementia / Learning Disabilities Service Manager at the Royal Liverpool and Broadgreen University Hospital.