Exploring GPs’ experience of difficult decisions in dementia patients with an acute illness

Problem

Dementia is a brain disease which causes disturbance in higher cortical functions such as learning capacity, memory, thinking, orientation, comprehension, calculation, language and judgement leading to a decline in their cognitive function which affects their social and occupational functioning, hence impairing their independent functioning. Although dementia is not, in itself an acute medical condition, it accounts for a large number of emergency hospital admission in older persons with a majority of these patients referred to hospital from home with acute illnesses such as respiratory and urinary tract infections. These account for 42% of all unplanned hospital admissions and recent studies show that acute hospital care is often not the most appropriate place for people with dementia and acute illness. In primary care there are guidelines for most health conditions but most guidelines do not give GPs enough guidance on how to make decisions for dementia patients with co-morbidities or acute illnesses. As GP assessment and admission is one of the pathways to acute hospital care, it is important to understand how GPs make decisions about acute care for people with dementia and intercurrent acute illness. This study aims to understand how these decisions are made, between GP, patient, family and carers and other health & social care providers in the presence or absence of advanced care plans.

Approach

This study will be a qualitative study carried out in a community setting, conducting approximately 15 semi-structured interviews with GPs who have managed dementia patients with acute illnesses. Our sample will be aimed at GPs who are experienced in caring for dementia patients who have acute illness including at home and in social care and both in and out of normal working hours. This diverse sample of in hours GPs and Out of hours GPs will facilitate a comparative analysis during data synthesis. The study will frame the analysis within a model of micro-politics – in which actions about a specific issue arise from discussion and negotiation between different agents during which trade-offs and compromises may be made in search of a solution. In this case the focus of the micro-politics will be decisions between GP, patient, family and carers and other health and social care providers about the management of acute illness in a person with dementia.

Findings

Results of this study will give more insight into Continuity of care (in hours service) versus Transactional care (Out of hours service) as it relates to dementia care in acute situations and the barriers GPs overcome when while making decisions for dementia patients in shared-care.

Consequences

Understanding more about decision making for dementia patients has implications for both equitable care for patients and helps to inform interventions and policies to optimise acute illness care for people with dementia.