general hospital care of people with delirium and dementia john gladman professor of medicine of...
TRANSCRIPT
General hospital care of people with delirium and dementia
John GladmanProfessor of Medicine of Older
People
How do we get research knowledge to those who might benefit from it?
The two issuesThe care of people with delirium and
dementia in hospital leaves much to be desired: I’ll describe research to address this
1-2 decades elapse between the generation of research knowledge and its widespread application: the “know-do” gap, the “implementation gap” or the “2nd translation gap”: I’ll describe what we did to address this
Specialist medical and mental health unit
Medical Crises in Older People research programme, 2008-2013
Nottingham University HospitalSurveyed the extent of the issueReview of best practiceDeveloped the unitEvaluated the unit
Specialist medical and mental health unit
• An existing geriatric medical ward was adapted
• Staff were trained in person-centred care• Extra staff were introduced: 3 registered
mental health nurses, 3 activity co-ordinators, 1 OT, 0.5 physio, 0.2 SALT, 0.1 psychiatrist
• Person-centred processes were introduced• The environment was altered• A proactive and inclusive approach to carers
was adopted
Medical and Mental Health Unit
Activities
Environment
Evaluation - methods• Randomised controlled trial• 600 patients – 300 to the unit and 300 to standard
care on geriatric or general medical wards• Outcomes
- during stay, quality of care and experience by non-participant observation- after discharge, carer satisfaction with care by questionnaire- at 6 months, “days at home”, physical and mental functions
• Economic study – costs taking health and social care perspective
Evaluation - results• Outcomes were generally poor (30% dead,
30% in a new care home)• No significant difference in days at home, or
physical or mental health functions at 6 months
• Significantly better carer satisfaction• Significantly better quality of care and
experience• Cost effective, savings in social care offset
extra hospital costs - 94% probability of cost-effectiveness (at £20,000/QALY threshold).
ImplicationsNot a panacea: not all can go to a unitNot a miracle, NEUTRAL hard outcomesGiven the end stage nature of the patients,
improved quality of care and experience (dignity?) valuable POSITIVE outcomes
Cost effective: worth having, affordableNeeds replicatingNeeds methods for transferring savings
Dissemination: geographical and population “reach”• Peer reviewed papers• Guidelines• Presentations at scientific conferences • Presentations to Alzheimer’s Society• Presentations to public • Traditional media (TV, radio, newspapers)• Social media• The Arts?
Arts in dissemination Artist in residencePoetry & spoken word, painting, sculpture,
performance, installationsGalleries, public spacesTheatreCinema
Today is Monday documentary• Commissioned by the Medical Crises in Older
People research programme• Justine Schneider, Pippa Foster, Owen Davies• Winner of Scottish Mental Health Film
Festival 2014 mid length documentary and the Jury Prize
• Permanent record of the unit in the study as it was in the trial
• Dissemination?• Training & education?
From the press…• Shot over eight days on a hospital ward, it
can be difficult to watch and certainly was not an easy film to make. “It was quite a daunting task to begin with,” said Davies. “But actually at the end of it, it felt like a privilege…from a filmmaker’s point of view and with the stories we bear witness to.”
• “They said to us, ‘You can come and do this as long as you don’t make a nice, schmaltzy, clean-cut film. We want the truth in this.’ That was the condition.”
Thank you