The effect of the environment on the care of older people with dementia or confusion in acute general hospital settings

Abstract

Aims: This study aimed to explore the impact of specifically designed ward-built environments on standards of care and outcomes for older people with dementia or other forms of confusion in acute general hospital wards in a large N.H.S. Trust in England, UK.

Background There are a dearth of studies that have looked comprehensively at the effect of the built environment on the care of older people with dementia in acute general hospital settings, and very few with sufficiently robust methodology with which to make generalisations (Fleming et al 2014; Marquardt et al 2014). Hence this study attempted to address current gaps in the available research in this area in order to promote more appropriate care.

Methods This was a comparative study of 180 older people with dementia or other forms of confusion on one standard medical ward and two purposively adapted dementia-friendly medical wards in a large acute general hospital in England. A mixture of both quantitative and qualitative methods was used to evaluate a range of clinical and quality issues.

Data analysis S.P.S.S. and R software were utilised for the quantitative elements of the data which were analysed using binomial regression, Poisson regression and chi-square test of association (Pallant 2005; R Core team 2013; Cormack 2000). The qualitative interview data was catalogued using NVivo (2012) and analysed using thematic content analysis. Descriptive statistics were also used where appropriate.

Results There were statistically significant differences between the standard medical ward and the dementia-friendly wards in terms of assessment of cognitive impairment and care planning regarding this, and the involvement of the patient and family in care. There was also a statistically significant difference in the levels of patient interaction and engagement between the dementia friendly wards and the standard medical ward. Statistically significant differences were also found in the unexpected readmission rates between the dementia friendly and standard medical wards.

Conclusion The findings indicate that purposively adapted dementia friendly hospital wards are not only thought by staff to help them provide more patient-centred care and support but are linked to more patient-centred and supportive behaviours and care practices. This research also suggests that purposively adapted built environments may contribute to more effective and ‘safer’ discharge. These findings have implications for practice and offer the potential to improve the quality of care for older people with dementia or confusion in acute general hospitals if the insights are further shared and explored.