title: What are the barriers to care integration for those at the advanced stages of dementia living in care homes in the UK? Health care professional perspective.
abstract: People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes and may often have complex needs requiring efficient and timely response by knowledgeable and compassionate staff. The aim of this study is to improve our understanding of health care professionals' attitudes and knowledge of the barriers to integrated care for people with advanced dementia. In-depth, interactive interviews conducted with 14 health care professionals including commissioners, care home managers, nurses and health care assistants in the UK. Barriers to care for people with advanced dementia are influenced by governmental and societal factors which contribute to challenging environments in care homes, poor morale amongst care staff and a fragmentation of health and social care at the end of life. Quality of care for people with dementia as they approach death may be improved by developing collaborative networks to foster improved relationships between health and social care services.
authors.affiliation: Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
authors.forename: Nuriye
authors.initials: N
authors.lastname: Kupeli
authors.affiliation: Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK.
authors.forename: Gerard
authors.initials: G
authors.lastname: Leavey
authors.affiliation: Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Harrington
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lord
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Moore
authors.affiliation: Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK; Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
authors.affiliation: Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
mesh_terms: D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated; D003704:Dementia / Q000451:nursing*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D009735:Nursing Homes; D036301:Qualitative Research; D012720:Severity of Illness Index; D013727:Terminal Care / Q000523:psychology; D006113:United Kingdom
keywords: care homes; dementia; integrated care; palliative care; qualitative research