Improving Acute Care of People with Dementia (IMPACT) Study

Funded by the Geller Commission, the focus of the IMPACT study is to reduce hospitalisation in people with dementia by examining the efficacy of various psychosocial and healthcare interventions and care home characteristics that might reduce the risk of hospitalisation in people with dementia. 

Umbrella review

People with dementia are at a 42% increased risk of admission to acute care and stay in acute care for up to 7 times longer than age-matched patients. Admission to acute care for people with dementia is associated with increased mortality, frailty, increased inpatient complications, and further cognitive and functional decline. Nevertheless, current research on psychosocial and healthcare interventions in dementia is sparse and spread across various intervention types with uncertain efficacy.

As part of the IMPACT study, we are systematically searching the literature for systematic reviews examining the effects of psychosocial and healthcare interventions on hospitalisation in people with dementia. Establishing a comprehensive narrative synthesis of the literature will allow us to make recommendations on successful interventions or make suggestions for future research. 
 

Systemic review

Preliminary evidence from our umbrella review suggested that advance care plans (ACP) may reduce hospitalisation in dementia. An ACP allows individuals to define their goals, values, and preferences for future medical treatment and care in collaboration with their family and health-care team. A previous systematic review has suggested that ACP may be associated with reduced hospitalisation in people with dementia, but there were limited studies available at the time meaning further research was required.

Therefore, another aspect of the IMPACT study is our systematic review examining the effect of ACP on hospitalisation in people with dementia, drawing on the latest available evidence. In particular, we are exploring how the creation or use of ACP can impact hospital admissions and length of stay in people with dementia. Identifying the successful aspects of ACP intervention may help to make efficient recommendations for broader ACP implementation. 
 

Longitudinal study

The cost of nursing home care for people with dementia is expected to reach £4.8 billion, with 30,000 more people with dementia expected to live in nursing homes by 2040. Recent literature has also suggested that individuals with Alzheimer’s dementia or related dementias (ADRD) are at 22% higher odds of having an avoidable nursing home-to-hospital transfer.

The final aspect of the IMPACT study is a longitudinal study on the association between care home characteristics and medications provided in care homes and hospitalisation in people with dementia. Using data from the MARQUE (Managing Agitation and Raising Quality of Life) study and the South London and the Maudsley NHS Foundation Trust’s Clinical Record Interactive Search system, we hope to identify potential modifiable care home factors that can be implemented into interventions to reduce hospitalisation in people with dementia. 

Collaborators

Public and patient involvement (PPI) 

We have collaborated with Public and patient involvement (PPI) members throughout the IMPACT study. They have helped with developing a comprehensive search strategy, highlighting key areas for analysis, and integrating lived experience in our interpretation of our findings.

Team members

Andrew Sommerlad
Gill Livingston
Alba Fernández-Sanlés
Connie Howard
Rudy Harris