Improving care in hospital

Being admitted to hospital is an unpleasant experience for anyone, but for people with dementia it can be particularly distressing. Research into hospital care is already helping to make improvements.

Consultant and researcher Dr Liz Sampson was funded by Alzheimer's Society and Bupa UK Foundation to study the effects of hospitalisation on behavioural symptoms of dementia.

'We found that there were quite high levels of agitation and behavioural symptoms for people with dementia coming into hospital. It's a very difficult environment because it's very busy and noisy and they get moved around a lot.'

'A lot of the time you read a report and it would say that people with dementia stay longer in acute hospital because of their behavioural problems. We found that actually that wasn't making them stay longer; it was external factors that were beyond their control. Dementia always gets the blame.'

Although this kind of research is much needed, it can be very difficult to carry out. Dr Sampson worked with two research assistants who followed 230 people from the point they were admitted in A&E.

'It's a very fast-paced environment in which to be doing research; people are being wheeled in and out all the time. It's really challenging because you have to get consent from the families. I'm amazed actually at the way the people with dementia and their carers were happy to participate in research at such a difficult time in their lives.'

Part of the research was carried out at North Middlesex Hospital in north London, where Dr Sampson works with geriatrician Dr Sophie Edwards, the hospital's dementia lead. Dr Edwards has used their observations of patients and carers to introduce dementia-friendly aspects onto the wards and last year was awarded the Kate Granger award for compassionate care.

Among these are a '10 things about me' document for each patient to help staff to understand the person's individual preferences and needs - similar to the Society's This is me - and a 'carer's passport' that allows carers to access wards outside of visiting times with free parking.

'The initiatives we have introduced are all about connecting with the patient as a person. We can learn more about a patient when we know more about them as people, about their life, and that, in turn, can improve the care we provide,' says Dr Edwards.

They have also been able to use their findings to help other staff at the hospital. 'We've probably trained over 600 staff in dementia awareness and dementia care. We've been able to focus on the research findings, so we've been able to boost the amount of training people have in managing agitation and difficult behaviours,' says Dr Sampson. 'We really try to put them in the shoes of someone with dementia and realise what it's like.

'I think we've realised that person‑centred care is as important in hospital as it is in the care home setting. A lot of what this project has helped us to understand is that a hospital is what we call a toxic environment and that it's not the fault of the person with dementia. It's that we put them into this very stressful environment and make their behaviour change. 

'Therefore we need to change the environment around the person.'