title: Interventions that support the creation of dementia friendly environments in health care: protocol for a realist review.
abstract: BACKGROUND
  Improving health-care outcomes for people living with dementia when they are admitted to hospital is a policy priority. Dementia friendly interventions in health care promote inclusion of patients and carers in decision-making and adapt practices and environments to be appropriate to the needs of people with cognitive impairment. While there has been a wealth of activity, the number of studies evaluating interventions is limited, and the majority focuses on reporting staff and organisational outcomes. By focusing on patient and carer outcomes, this review will aim to develop an explanatory account of how and in what circumstances dementia friendly environments in health care work for people living with dementia and with what outcomes.
  
  
  METHODS
  Realist review is a theory-driven method which seeks to produce explanatory accounts of why interventions work and specifically, what combination of components are most effective in producing particular outcomes. Stakeholder interviews, a review of the literature, and an expert steering group workshop will be used to explore the assumptions behind interventions that are designed to enhance health care for people living with dementia to understand the underlying programme theories. The review will focus on studies that report patient and carer outcomes, including involvement in decision-making, length of stay and referral to long-term care, adverse incidents (e.g. patient distress, delirium falls, nutrition and hydration and infection), antipsychotic medication prescribing, evidence of patient-centred care and patient and carer satisfaction.
  
  
  CONCLUSIONS
  The review will provide an explanatory model about how dementia friendly interventions in hospital settings improve outcomes for people living with dementia and their family carers and in what circumstances for future testing and evaluation of future dementia friendly initiatives.
  
  
  BACKGROUND
  PROSPERO CRD42015017562.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. m.j.handley@herts.ac.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Handley
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. f.bunn@herts.ac.uk.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. c.goodman@herts.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
mesh_terms: D017028:Caregivers; D003072:Cognition Disorders / Q000628:therapy; D003695:Delivery of Health Care; D003704:Dementia / Q000628:therapy; D004777:Environment; D006760:Hospitalization; D006801:Humans; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D012107:Research Design; D000078202:Systematic Reviews as Topic