Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

摘要: Background Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also their carers the staff who care them. Improving experience of dementia has been recognised as a priority. Objectives To understand them to assess what we know about improving care. Review methods We undertook three systematic reviews: (1) hospital, (2) interventions improve (3) effectiveness cost-effectiveness Reviews 1 2 sought primary qualitative studies were analysed using meta-ethnography. 3 comparative economic evaluations An interweaving approach overarching synthesis was used integrate findings across reviews. Data sources Sixteen electronic databases searched. Forwards backwards citation chasing, author contact grey literature searches undertaken. Screening title abstracts full texts performed by two reviewers independently. A quality appraisal all included Results Sixty-three (reported 82 papers) review 1, 14 16 2, 25 26 3. found that when delivering more person-centred care, experienced this better The line argument, which represents conceptual whole, ‘a change culture is needed before become routine’. From reviews 3, there some evidence improvements from activities, training, added capacity inclusion carers. In consultation internal external stakeholders, developed into 12 DEMENTIA CARE pointers service change: key institutional environmental practices processes could help hospital. Limitations Few explored perspectives dementia. measurement consistent. Methodological variability small number intervention limited ability draw conclusions on effectiveness. Conclusions suggests that, transformation organisational ward cultures supports values status Changes need cut hierarchies training systems facilitate working patterns interactions enable both physical emotional Future research needs identify how such changes implemented, they maintained long term. do this, well-designed controlled improved reporting details elevate available comparisons different are required. Study registration This study registered PROSPERO CRD42018086013. Funding project funded National Institute Health Research (NIHR) Services Delivery programme will published Research; Vol. 8, No. 43. See NIHR Journals Library website further information. Additional funding provided Collaboration Leadership Applied Care South West Peninsula.