Person-centred hydration care for older people living with dementia in acute hospital wards: A case study

Purpose: Admission to acute hospital can be detrimental to the physical and psychological health of older people living with dementia (OPLWD). Evidence demonstrates that currently, person-centred dementia care within hospitals remains in flux and staff struggle to meet the biopsychosocial needs of people living with dementia. This thesis uses the concept of person-centred care to explore how oral hydration care is delivered for older people living with dementia admitted to an acute hospital, a topic infrequently explored in research.
Methods: A multiple case study was conducted across three wards within one acute hospital. Contextual hospital data were collected through five interviews with senior staff and policy documentary analysis. Ward-level data collection comprised 132 hours of direct observation with 13 OPLWD and staff providing care, 37 interviews with staff, people living with dementia and their relatives, and documentary analysis of 38 clinical patient-records. Data were analysed using framework approach.
Findings: Organisationally, oral hydration care for OPLWD is not prioritised; it is not a topic of national importance with required reporting.
At ward level, oral hydration care is not prioritised by healthcare staff who are influenced by organisational priorities. Staff hydration roles are disjointed, and drink delivery outsourced. The approach to facilitating hydration care between and within ward staff, OPLWD and their relatives is insufficient to consistently provide person-centred hydration care. By utilising: Communication, Action, Resources and Environmental considerations, encompassing staff’s approach and the needs of older people living with dementia and their relatives, person-centred oral hydration CARE could be facilitated.
Conclusion: This thesis brings the concepts of person-centred care and hydration care for OPLWD admitted to an acute hospital together for the first time, demonstrating that person-centred hydration care is complex and not currently prioritised. Acute hospitals should improve the person-centred delivery of oral hydration care for OPLWD, to improve their health and wellbeing.

This PhD was made possible through funding provided by the Mona Grey Scholarship