title: Preparation to care for confused older patients in general hospitals: a study of UK health professionals.
abstract: OBJECTIVE
  in the UK, two-thirds of patients in general hospitals are older than 70, of whom half have dementia or delirium or both. Our objective was to explore doctors, nurses and allied health professionals' perceptions of their preparation to care for confused older patients on general hospital wards.
  
  
  METHODS
  : using a quota sampling strategy across 11 medical, geriatric and orthopaedic wards in a British teaching hospital, we conducted 60 semi-structured interviews with doctors, nurses and allied healthcare professionals and analysed the data using the Consensual Qualitative Research approach.
  
  
  RESULTS
  : there was consensus among participants that education, induction and in-service training left them inadequately prepared and under-confident to care for confused older patients. Many doctors reported initial assessments of confused older patients as difficult. They admitted inadequate knowledge of mental health disorders, including the diagnostic features of delirium and dementia. Handling agitation and aggression were considered top priorities for training, particularly for nurses. Multidisciplinary team meetings were highly valued but were reported as too infrequent. Participants valued specialist input but reported difficulties gaining such support. Communication with confused patients was regarded as particularly challenging, both in terms of patients making their needs known, and staff conveying information to patients. Participants reported emotional and behavioural responses including frustration, stress, empathy, avoidance and low job satisfaction.
  
  
  CONCLUSIONS
  : our findings indicate that a revision of training across healthcare professions in the UK is required, and that increased specialist support should be provided, so that the workforce is properly prepared to care for older patients with cognitive problems.
authors.affiliation: Division of Psychiatry and Applied Psychology, University of Nottingham, School of Medicine, Nottingham, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Griffiths
authors.affiliation: Division of Health and Social Care Research, King's College London, School of Medicine, London, UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Knight
authors.affiliation: Nottingham University Hospitals NHS Trust, Health Care of Older People, Nottingham, UK.
authors.forename: Rowan
authors.initials: R
authors.lastname: Harwood
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, School of Medicine, Nottingham, UK.
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy; D003693:Delirium / Q000628:therapy*; D003704:Dementia / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics / Q000193:education*; D006282:Health Personnel / Q000193:education* / Q000523:psychology*; D006301:Health Services Needs and Demand; D006769:Hospitals, General; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D010348:Patient Care Team; D006113:United Kingdom
keywords: delirium; dementia; education; general hospitals; older people; workforce