When people with dementia are admitted to hospital wards, this requires the assistance of nurses or health care assistants. During our earlier study examining what happens when patients with dementia refuse hospital care, we noticed that toileting is an important trigger that can lead to significant distress for patients (if immediate toileting assistance needs are not met), for families (who see their loved one in undignified circumstances) and for other patients (who may become afraid by the other person’s distress) and can increase the potential for dehumanization (staff not recognizing the person or their needs).
When a person living with dementia is in hospital, it is often usual for staff to use incontinence pads or to insert a urinary catheter rather than help the person to go to the toilet. This is often because continence problems are a risk factor for falls. However, catheters can lead to significant risks of infection (that can become life-threatening) and not being able to independently go to the toilet, can reduce their opportunities to regain mobility and independence. This means that hospitals may be causing incontinence in patients with dementia.
Our consultations with families identified that they had a lot of anger about continence care when their partner with dementia was in hospital. Many reported that their partner with dementia, who was continent, became classified as incontinent within days of admission and required catheterisation.
In response, our study will conduct detailed research observing how ward staff and clinical teams care for patients with dementia during their admission. We will describe how toileting practices and routines impact on the care of people with dementia in acute hospital wards within three hospitals in different parts of England and Wales. During our observations we will carry out in-depth case studies of patients and interview them and their families about their experiences. Because there is very little published research on continence care for patients with dementia in hospitals, we will also review the literature to identify successful strategies used in other care settings. This will help us to bring together the knowledge that exists on how to promote the best ways to manage the toileting needs of patients with dementia in hospital wards.
At the end of the project we will provide a detailed understanding of how hospital care could change to improve care and the experiences of patients and their families. We will use this detailed research to develop new training and information for hospital staff and families. This will include raising awareness of the risks associated with current practices, which will be accessible for anyone caring for a person with dementia. We will also identify alternative ways to manage this important but neglected issue that can be implemented in wards and tested in future research studies. Our goal is to improve everyday care for patients with dementia in all hospitals.
Our latest report carried out by Professor Katie Featherstone and Dr Andy Northcott, and a wider interdisciplinary team presents the findings of our latest new ethnographic research, Understanding how to facilitate continence for people with dementia in acute hospital setting.
