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Going home? An ethnographic study of assessment of capacity and best interests in people with dementia being discharged from hospital

Lookup NU author(s): Dr Marie Poole, Professor John Bond, Professor Dame Louise Robinson, Professor Julian Hughes



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: A significant proportion of patients in an acute hospital is made up of older people, many of whom have cognitive impairment or dementia. Rightly or wrongly, if a degree of confusion is apparent, it is often questioned whether the person is able to return to the previous place of residence. We wished to understand how, on medical wards, judgements about capacity and best interests with respect to going home are made for people with dementia and how decision-making around hospital discharge for people with dementia and their families might be improved. Our research reflects the jurisdiction in which we work, but the importance of residence capacity rests on its implications for basic human rights.Methods: The research employed a ward-based ethnography. Observational data were captured through detailed fieldnotes, in-depth interviews, medical-record review and focus groups. Themes and key issues were identified using constant comparative analysis of 29 cases. Theoretical sampling of key stakeholders was undertaken, including patients with dementia (with and without residence capacity), their relatives and a range of practitioners. The research was carried out in three hospital wards (acute and rehabilitation) in two hospitals within two National Health Service (NHS) healthcare trusts in the North of England over a period of nine months between 2008 and 2009.Results: Our analysis highlights the complexity of judgements about capacity and best interests in relation to decisions about place of residence for people with dementia facing discharge from hospital. Five key themes emerged from data: the complexity of borderline decisions; the requirement for better understanding of assessment approaches in relation to residence capacity; the need for better documentation; the importance of narrative; and the crucial relevance of time and timing in making these decisions.Conclusions: We need: more support and training for practitioners, as well as support for patients and families; clarity about the information to be imparted to the person with dementia; more advocacy for people with dementia; appropriate assessments embedded in routine clinical practice; the patient with dementia to be centre-stage; and properly resourced step-down or rehabilitation units to facilitate timely and good decision-making about place of residence.

Publication metadata

Author(s): Poole M, Bond J, Emmett C, Greener H, Louw SJ, Robinson L, Hughes JC

Publication type: Article

Publication status: Published

Journal: BMC Geriatrics

Year: 2014

Volume: 14

Print publication date: 23/04/2014

Online publication date: 23/04/2014

Acceptance date: 07/04/2014

Date deposited: 03/09/2014

ISSN (electronic): 1471-2318

Publisher: BioMed Central Ltd.


DOI: 10.1186/1471-2318-14-56


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Funder referenceFunder name
Northumbria Healthcare NHS Foundation Trust
PB-PG-0906-11122National Institute for Health Research (NIHR)