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Experience of general hospital care in older patients with cognitive impairment: are we measuring the most vulnerable patients’ experience?
  1. Sarah E Goldberg1,
  2. Rowan H Harwood2
  1. 1Division of Rehabilitation and Ageing, University of Nottingham, Queens Medical Centre, Nottingham, UK
  2. 2Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
  1. Correspondence to Dr Sarah Goldberg, Division of Rehabilitation and Ageing, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; sarah.goldberg{at}

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Healthcare is more than a technical exercise in meeting physical healthcare needs; it has emotional, psychological, social and cultural dimensions. Patients, the public and government expect healthcare providers to ensure that patients’ experiences are good. This represents an important outcome for health services1 and is one of the five outcome domains in the UK NHS Outcomes Framework,2 which is intended to inform healthcare commissioning.

Two-thirds of general hospital beds are occupied by older people3; half of these older people have cognitive impairment—mostly dementia and/or delirium. Cognitive impairment is a spectrum and for some (particularly those with delirium) cognition will fluctuate during their hospital stay, but a quarter of older patients in hospital will have moderate or severe cognitive impairment (with a Mini Mental State Examination score of <18).4 They will be disorientated to time or place, have problems of attention and memory and following simple commands. These patients are mostly very old (half will be over 85 years old), acutely ill and have many comorbidities.4 Many are reaching the end of their natural life5; there is a palliative element to their care, making the quality of their care and their experience of being in hospital of greater importance. Such patients have many functional problems (incontinence, needing help when moving and assistance with meals) and behavioural and psychological problems (delusions, hallucinations, agitation and aggression and apathy), which together with their acute illness and comorbidities make them especially vulnerable to a poor experience.4 Reports have criticised the quality of care of these patients6 ,7 and poor quality care is likely to result in poor patient experience. Therefore we examined the methods currently used to measure patient experience or care quality and considered their feasibility for use with older people who are cognitively …

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