Dr Sabarigirivasan Muthukrishnan
Cardiff & Vale NHS Trust
REACT Project: an investigation of the active components of a specialist home treatment intervention to proevent hospital admission of people with dementia in crisis in the community
Health and Care Research Wales
Aim of the research
Improve a home treatment dementia crisis service.
Background to the research
People with dementia in crisis can receive home treatment that prevents admission to hospital. They prefer home to hospital treatment and care. Home treatment has better clinical and other outcomes.
The essential components of home treatment for preventing hospital admission during dementia crisis are not known.
Problem being addressed and why this research is important
Hospital admission in dementia can add to the problems experienced by patients and their carers. It is also more expensive than home treatment. It is important to find out what can prevent hospital admission during a dementia crisis.
A dementia crisis is when a person with dementia is at risk of serious harm or death. They will present to a health or social care professional in a state of physical neglect, at risk of suicide, in squalid home conditions, with a carer unwilling or unable to continue caring, lost (unsafe outside and unable to find their way home), exposed to abuse, or resisting/refusing services.
This study will find out what happens before, during and after dementia crisis. It will identify important factors for the avoidance of hospital admission. It will compare management in the community by a mental health crisis team with an in-patient mental health service. It will find what is important about home treatment for preventing hospital admission.
Data will be collected in the following ways:
– Medical record review of all dementia crisis referrals for home treatment and in-patient treatment in one geographical location over a 12 month period
– Observation of the management of 30-60 patients with dementia in crisis
– Interviews with 30 patient and their carers after dementia crisis
– Interviews with 20-30 healthcare professionals managing dementia crisis
– Focus groups with the home treatment dementia crisis team and the in-patient mental health team
The analysis will examine what home treatment in dementia crisis is and how, when and why it can prevent hospital admission. It will also examine what in-patient hospital treatment by a mental health team involves and how, when and why it is different to home treatment. By comparing these cases, we will be able to work out key treatments, behaviours, education and context for home treatment to prevent hospital admission.
Benefits to patients, the public and the NHS
We will use our findings to develop a manual for the delivery of home treatment in dementia crisis.
The practices set out in this manual will be informed by our findings and theory so that they can be used by other teams across the UK.
We will then plan a follow-on study to compare the manualised approach with other models of home treatment for crisis in dementia used across Wales.
A group of people with dementia and their carers will help with the project. The group leader will coordinate the group in helping prepare documents, plan processes and disseminate study findings. The group leader and another person affected by dementia will join the project Advisory Group.
The findings of the research will be presented at conferences and a paper will be written for
publication. A lay person summary will be made available to policy makers.