Abstract
AbstractThere is growing recognition of the importance of dignity and support with eating as markers of high-quality and older-person-centred hospital services. We use data on these markers from the national Adult Inpatient Survey for England to build up statistical evidence on older people's experiences. We find that poor and inconsistent experiences of being treated with dignity and respect, and of receiving support with eating, affect a substantial proportion of inpatients across the vast majority of acute hospital trusts. There has been remarkably little change over time, although small improvements provide some grounds for optimism relating to policy developments in the period following the Francis Inquiry. Amongst people over 65, the prevalence of inconsistent and poor experiences of dignity and support with eating was higher amongst the ‘oldest of the old’ (inpatients aged over 80), individuals who experience a long-standing limiting illness or disability, and women. The highest rates of prevalence were observed amongst disabled women over 80. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out from logistic regression analysis as having consistent, large associations with lack of support with eating. These factors provide potential policy levers since they are within the control of hospitals to a certain extent. In drawing lessons from our analysis for inspection, regulation and monitoring, we highlight the importance of inequalities analysis – including systematic disaggregation and separate identification of at risk sub-groups (e.g. older disabled women) – rather than relying on a ‘population average approach’.
Highlights
The importance of dignity and support with eating as key markers of high-quality and older-person-centred hospital and long-term care services is increasingly recognised in England and internationally
The analysis builds on previous work we have undertaken in partnership with the British Equality and Human Rights Commission (EHRC), which has a statutory duty to monitor and report to Parliament on national equality and human rights outcomes
The development of indicators that capture the extent to which hospital services maintain and support older people’s dignity and respect, and that meet their needs for support with activity of daily living (ADL), was identified through the stakeholder consultation as an important priority
Summary
The importance of dignity and support with eating as key markers of high-quality and older-person-centred hospital and long-term care services is increasingly recognised in England and internationally. We report our key empirical findings on older people’s experiences of dignity and support with meeting basic needs such as eating during hospital stays in England using the Adult Inpatient Survey (AIS), including in-depth analysis for 2014 in the context of long-term and more recent trends, 2004–2019. The growing number of national and international surveys used to measure patient experience are reviewed in Garratt et al (2008), Fujisawa and Klazinga (2017) and Larson et al (2019), and a new set of internationally comparable patient experience indicators were included in the recent Health at a Glance report (Organisation for Economic Co-operation and Development (OECD), 2019a).2 The latter notes that the patient perspective on the outcomes and experience of their care is essential in driving continuous quality improvement of health services and in increasing the responsiveness of health policy and health systems to different people’s needs. To set the 2014 data in context, we report overall trends for the period 2004–2019 using standard AIS datasets available at the UK Data Archive and published CQC data, without fine-grained sub-group information
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