Assessment of capacity and best interests in dementia: on going home from hospital
Award Number
PB-PG-0906-11122Programme
Research for Patient BenefitStatus / Stage
CompletedDates
2 April 2008 -1 September 2011
Duration (calculated)
03 years 04 monthsFunder(s)
NIHRFunding Amount
£221,715.00Funder/Grant study page
NIHRContracted Centre
Northumbria Healthcare NHS Foundation TrustPrincipal Investigator
Professor Julian HughesWHO Catergories
Methodologies and approaches for risk reduction researchModels across the continuum of care
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 89 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | PB-PG-0906-11122 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20080402 |
| End Date | 20110901 |
| Duration (calculated) | 03 years 04 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | Northumbria Healthcare NHS Foundation Trust |
| Funding Amount | £221,715.00 |
Abstract
Issues of capacity are very clearly raised in the context of dementia. The passage of the Mental Capacity Act 2005, which comes partially into force in April 2007, has focused attention on the assessment of capacity and the notion of best interests. One of the most common assessments on general medical wards concerns whether or not a person with dementia has the capacity to decide to return home. Where the person lacks the requisite capacity, a best interests decision has to be made. Despite attempts to operationalize assessments of capacity, both the assessment of this particular capacity and judgements about best interests to do with decisions about going home are difficult. Such day to day decisions about vulnerable patients whose liberty is at stake are clearly of great importance.Plan of Investigation Phase I will involve a broad literature review to identify themes and consensus views. Phase II will involve participant observation on medical wards with interviews of patients, their carers and members of the multidisciplinary team, with follow-up interviews of patients and carers; and a series of focus groups using case scenarios, with older people, voluntary organizations and professionals, to reflect on the data derived from the literature, observation and interviews. Phase III will centre, first, on the development of an intervention to improve the assessment of capacity and best interests in this situation; secondly, having introduced the intervention, the process of decision-making will be evaluated. Phase IV will involve further analysis of the data, writing up and dissemination. Potential Impact Decisions to discharge people with dementia from medical wards have to be made every day. These decisions are not easy: assessments of capacity and best interests in this type of situation are not straightforward. This research will study how these decisions are made in the NHS. Such decisions have a direct impact on the lives of patients and their families. They also affect the use of resources, for instance for community support and for long-term care. An intervention that clarifies the processes of assessment in such situations should increase the likelihood that decisions will be in the best interests and hence to the benefit of patients. As well as being person-centred in this way, the research will also elucidate the notions of capacity and best interests more generally.
Aims
Decisions about going home from hospital involve judgements about both the person’s capacity and best interests. The research question is: How could we improve decisions about whether or not confused people should go home from hospital? There would be six related objectives: (i) To describe the range of factors involved in judgements about capacity to make decisions about going home; (ii) To investigate how the process of making these judgements could be improved; (iii) To evaluate how a person’s best interests with respect to place of residence is determined; (iv) To consider how this process might be improved in routine discharge planning; (v) To develop an intervention to improve decisions concerning people with dementia going home from hospital; (vi) To evaluate the intervention.