The use of constant observation with people with dementia in hospitals: a mixed-methods systematic review

Melanie Handley, Danai Theodosopoulou, Nicky Taylor, Rebecca Hadley, Claire Goodman, Rowan Harwood, Rosemary Phillips, Alex Young, Claire Surr

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Constant observation is used in hospitals with people with dementia to manage their safety. However, opportunities for proactive care are not consistently recognised or utilised. A systematic review of constant observation was conducted to understand measures of effectiveness and facilitators for person-centred approaches.
Electronic databases were searched between 2010 – 2022. Four reviewers completed screening, quality assessments and data extraction with 20% checked for consistency. Findings were presented through narrative synthesis (PROSPERO registration CRD42020221078).
Twenty-four studies were included. Non-registered staff without specific training were the main providers of constant observation. Assessments and processes clarifying the level of observation encouraged reviews that linked initiation and discontinuation to a patient’s changing needs. Examples of person-centred care, derived from studies of volunteers or staff employed to provide activities, demonstrated meaningful engagement could reassure a person and improve their mood. Proactive approaches that anticipated distress were thought to reduce behaviours that carried a risk of harm but supporting evidence was lacking.
Non-registered staff are limited by organisational efforts to reduce risk, leading to a focus on containment. Trained staff who are supported during constant observation can connect with patients, provide comfort and potentially reduce behaviours that carry a risk of harm.
Original languageEnglish
JournalAging and Mental Health
Publication statusAccepted/In press - 22 May 2023


  • Constant Observation
  • Dementia
  • Person-centre
  • hospitals
  • Systematic Review


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