TY - CONF
T1 - Going home? A study of capacity and best interests in people with dementia being discharged from hospital
AU - Emmett, Charlotte
PY - 2014/5/20
Y1 - 2014/5/20
N2 - A significant proportion of patients in an acute hospital is madeup of older people, many of whom have cognitive impairment ordementia. Rightly or wrongly, if a degree of confusion is apparent,it is often questioned whether the person is able to return to theprevious place of residence. We wished to understand how, onmedical wards, judgements about capacity and best interests withrespect to going home are made for people with dementia andhow decision-making around hospital discharge for people withdementia and their families might be improved. Our research useda ward-based ethnography. We observed, took detailed fieldnotes,undertook in-depth interviews, reviewed medical records and heldfocus groups. Themes and key issues were identified in 29 cases.The research involved people with dementia (with and withoutresidence capacity), their relatives and a range of practitioners.Our analysis highlights the complexity of judgements aboutcapacity and best interests in relation to decisions about place ofresidence for people with dementia facing discharge from hospital.Five key themes emerged from data: the complexity of borderline decisions; the requirement for better understanding of assessmentapproaches in relation to residence capacity; the need for betterdocumentation; the importance of narrative; and the crucialrelevance of time and timing in making these decisions.In conclusion, we need: more support and training for practitioners, aswell as support for patients and families; clarity about the informationto be imparted to the person with dementia; more advocacy forpeople with dementia; appropriate assessments embedded in routineclinical practice; the patient with dementia to be centre-stage; andproperly resourced step-down or rehabilitation units to facilitatetimely and good decision-making about place of residence.
AB - A significant proportion of patients in an acute hospital is madeup of older people, many of whom have cognitive impairment ordementia. Rightly or wrongly, if a degree of confusion is apparent,it is often questioned whether the person is able to return to theprevious place of residence. We wished to understand how, onmedical wards, judgements about capacity and best interests withrespect to going home are made for people with dementia andhow decision-making around hospital discharge for people withdementia and their families might be improved. Our research useda ward-based ethnography. We observed, took detailed fieldnotes,undertook in-depth interviews, reviewed medical records and heldfocus groups. Themes and key issues were identified in 29 cases.The research involved people with dementia (with and withoutresidence capacity), their relatives and a range of practitioners.Our analysis highlights the complexity of judgements aboutcapacity and best interests in relation to decisions about place ofresidence for people with dementia facing discharge from hospital.Five key themes emerged from data: the complexity of borderline decisions; the requirement for better understanding of assessmentapproaches in relation to residence capacity; the need for betterdocumentation; the importance of narrative; and the crucialrelevance of time and timing in making these decisions.In conclusion, we need: more support and training for practitioners, aswell as support for patients and families; clarity about the informationto be imparted to the person with dementia; more advocacy forpeople with dementia; appropriate assessments embedded in routineclinical practice; the patient with dementia to be centre-stage; andproperly resourced step-down or rehabilitation units to facilitatetimely and good decision-making about place of residence.
M3 - Paper
T2 - 24th Alzheimer Europe Conference<br/>20–22 October 2014 / Glasgow<br/>
Y2 - 20 May 2014 through 22 May 2014
ER -