1. General hospital care of people with delirium and dementia John Gladman Professor of Medicine of Older People

2. How do we get research knowledge to those who might benefit from it?

3. The two issues The care of people with delirium and dementia in hospital leaves much to be desired: I’ll describe research to address this 1-2 decades elapse between the generation of research knowledge and its widespread application: the “know- do” gap, the “implementation gap” or the “2 nd translation gap”: I’ll describe what we did to address this

5. Specialist medical and mental health unit Medical Crises in Older People research programme, 2008-2013 Nottingham University Hospital Surveyed the extent of the issue Review of best practice Developed the unit Evaluated the unit

6. Specialist medical and mental health unit An existing geriatric medical ward was adapted Staff were trained in person-centred care Extra staff were introduced: 3 registered mental health nurses, 3 activity co-ordinators, 1 OT, 0.5 physio, 0.2 SALT, 0.1 psychiatrist Person-centred processes were introduced The environment was altered A proactive and inclusive approach to carers was adopted

7. Medical and Mental Health Unit

8. Activities

9. Environment

10. Evaluation - methods Randomised controlled trial 600 patients – 300 to the unit and 300 to standard care on geriatric or general medical wards Outcomes - during stay, quality of care and experience by non- participant observation - after discharge, carer satisfaction with care by questionnaire - at 6 months, “days at home”, physical and mental functions Economic study – costs taking health and social care perspective

11. Evaluation - results Outcomes were generally poor (30% dead, 30% in a new care home) No significant difference in days at home, or physical or mental health functions at 6 months Significantly better carer satisfaction Significantly better quality of care and experience Cost effective, savings in social care offset extra hospital costs - 94% probability of cost-effectiveness (at £20,000/QALY threshold).

12. Implications Not a panacea: not all can go to a unit Not a miracle, NEUTRAL hard outcomes Given the end stage nature of the patients, improved quality of care and experience (dignity?) valuable POSITIVE outcomes Cost effective: worth having, affordable Needs replicating Needs methods for transferring savings

13. Dissemination: geographical and population “reach” Peer reviewed papers Guidelines Presentations at scientific conferences Presentations to Alzheimer’s Society Presentations to public Traditional media (TV, radio, newspapers) Social media The Arts?

14. Arts in dissemination Artist in residence Poetry & spoken word, painting, sculpture, performance, installations Galleries, public spaces Theatre Cinema

15. Today is Monday documentary Commissioned by the Medical Crises in Older People research programme Justine Schneider, Pippa Foster, Owen Davies Winner of Scottish Mental Health Film Festival 2014 mid length documentary and the Jury Prize Permanent record of the unit in the study as it was in the trial Dissemination? Training & education?

16. From the press… Shot over eight days on a hospital ward, it can be difficult to watch and certainly was not an easy film to make. “It was quite a daunting task to begin with,” said Davies. “But actually at the end of it, it felt like a privilege…from a filmmaker’s point of view and with the stories we bear witness to.” “They said to us, ‘You can come and do this as long as you don’t make a nice, schmaltzy, clean-cut film. We want the truth in this.’ That was the condition.”

17. More information john.gladman@nottingham.ac.uk www.nottingham.ac.uk/mcop

18. Thank you