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Best practice in crisis care for people with dementia

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Crisis can occur in a person with dementia for many reasons that may be related to the person’s physical health, risks and hazards at home, social changes, behavioural changes, or problems that a family carer is facing. Resolution may require a variety of different tactics such as home adaptations, involving neighbours or friends, accessing specialist homecare services or professional healthcare support, and educating carers and family members.

In many areas across the UK there are teams that can help manage crisis in people with dementia through providing support, advice, and education to both people with dementia and their family and friends. However, this type of care is not standardised across the UK, and the teams differ in respect to the services they provide, the professional backgrounds of the staff, and even what the team itself is called. Some teams will conduct assessments and design a plan to support the person with dementia and the carer at home, whereas other teams may input less directly by conducting a review of medication, arranging social care packages and liaising with the person with dementia’s GP. Most teams will include community psychiatric nurses, but other professions such as occupational therapists and psychiatry vary and there are no set criteria for the types of roles that must be present in a team.

The effectiveness of teams that manage crisis in people with dementia has not been established because there has not been enough research conducted with them. Additionally, teams do not exist in every area, as some patients are instead looked after by their local community mental health teams (CMHTs). We don’t know if patients under the care of CMHTs are disadvantaged by being unable to access specific teams who manage crisis in people with dementia.

Our programme of research is called Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT) and our first step is to find out about current practice across several teams in different areas of England. We are going to interview members of staff from teams that manage crisis in people with dementia, people with dementia who have recently made use of these teams, and carers of people with dementia who have made use of these teams. We want to find out what current practice looks like, and what people’s experience of giving and receiving care are. We will also be asking about things that help teams provide the very best care, and things that get in the way of providing the very best care.

In addition to our interviews, we will be holding focus groups with staff members, people with dementia who have used the services of the teams, carers, and other stakeholders such as managers. We will be asking people with dementia and carers of people with dementia to not only take part in the focus groups, but to help us run them, ask the questions and guide the discussions. This is important to add an extra dynamic to the groups, and will allow our enquiry to reach our participants on more sensitive and empathic level.

When we have collected all the information from the interviews and focus groups we will begin to build a toolkit of resources that can help teams who manage crisis in people with dementia to be more effective. We will be developing a measure alongside the toolkit that will show us how well teams currently care for people with dementia, and the toolkit will assist them in improving what they do so that all teams can provide the very best practice. This process will take approximately one year, and after that we will begin a trial to find out if the toolkit that we have produced is effective in assisting teams to help people with dementia who experience a crisis stay at home instead of being admitted to hospital.

This is a very exciting programme of research that will improve the quality of life and the healthcare experience of both people with dementia who experience a crisis and their families. We’ll be blogging throughout the programme to let everyone know our progress and findings and we welcome your comments o

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