Introduction Introduction

Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia

Despite one quarter of acute NHS hospital beds being occupied by people with dementia, there is little research on how best to look after these people in hospital. They are exceptionally vulnerable and at high risk of serious complications.

Researchers at the University of East Anglia, with national and international collaborators, are working with a wide range of stakeholders (health professionals, people living with dementia and their carers) to optimise acute hospital care. The Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia programme (PERFECTED) is aiming to improve hospital care for patients living with dementia who break their hip.

We want to find out how to optimise the care and rehabilitation of people with dementia who break their hip by creating an Enhanced Recovery Pathway – a way of helping patients recover quicker after surgery. Through working together, health professionals, people living with dementia, and their carers and researchers will create and pilot the pathway to see how optimising care can improve outcomes, both for this patient group and those who care for them.

How will PERFECTED work?

PERFECTED is comprised of four work packages that will be drawn together to create and evaluate the Enhanced Recovery Pathway (ERP). Using examples of best practice from across the globe, our team of national and international experts will work with patients, carers and clinicians from across East Anglia, Nottinghamshire, Yorkshire, London and Scotland to develop and refine the ERP, creating guidelines for its use and bespoke training materials for its implementation.

We will then conduct a pilot study in hospitals across the UK to assess the feasibility of procedures and provide information to inform a definitive trial. Patient and Public Involvement is a key component of the study and, across the duration of the study, members of the public will be involved as part of the steering group and as part of Service User Advisory Groups.

For more information, please visit the PERFECTED Project website, or follow our Twitter (@perfectedERP) and Youtube channels.

Research Design and Outputs Research Design and Outputs

The study is made up of four work packages:

Work Package 1 - establishing best practice

The aim of the first work package was to find out about existing practice for people with dementia who break their hip. This was carried out in several phases: a systematic review of research literature; surveys in England and internationally; observations of care carried out on hospital ward and A & E; interviews and focus groups with patients, carers and professionals and the development of of an initial Enhanced Recovery Pathway. Lay researchers were involved in carrying out observations in hospital, interviews and focus groups.

Work Package 2 - Optimising care for patients with dementia and hip fracture

In this work package we conducted Action research whereby the initial Enhanced Recovery Pathway was tried out in ward environments. The aim of this work package was to see what actually works in real life.

Work Package 3 - Pilot study of Enhanced Recovery Pathway

This work package is currently in progress. The work package involves piloting the Enhanced Recovery Pathway in a cluster randomised controlled trial which compares the use of Enhanced Recovery Pathway versus Usual Care. It also involves interviews and focus groups with key stakeholders. The aim is to ascertain how feasible the procedures are and to gather information which would inform a definitive trial.

Work Package 4 - Consensus Conference and dissemination of findings

In the last work package there will be a consensus conference to discuss the outcomes of the study. Findings will be disseminated in a variety of forums including service user outputs, peer reviewed journals and conference presentations.


Gill, N., Hammond, S. P., Cross, J., Smith, T., Lambert, N. and Fox, C. (2017) Optimising care for patients with cognitive impairment and dementia following hip fracture. Z Gerontol Geriat. doi: 10.1007/s00391-017-1224-4. Available from

Hammond, S.P., Cross, J.L., Poland, F.P., Patel, M., Penhale, B., Smith, T.O. and Fox, C. (2016) Freedom of Information Act: scalpel or just a sharp knife? Journal of Medical Ethics. doi:10.1136/medethics-2016-103609. Available from

Smith, T., Hameed, Y., Cross, J., Sahota, O. and Fox, C. (2013) Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics. doi: 10.1016/j.archger.2013.04.009 Available from

Smith, T., Hameed, Y., Henderson, C., Cross, J., Sahota, O. and Fox, C. (2013) Effectiveness of post-operative management strategies for adults with dementia following hip fracture surgery, In: The Cochrane Collaboration. Available from


Patel, M., Lee, S., Hammond, S.P. and Fox, C. Contributors: Donaldson, D., Cross, J., Poland, F., Smith, T., Penhale, B., Lambert, N., Varley, A. and Backhouse, T. European Geriatric Medicine International Congress (EUGMS) (Oct 2016) "Caring for people with hip fracture and cognitive impairments: qualitative findings from the PERFECTED Research Programme" PDF

Backhouse, T., Lambert, N., Varley, A., Hammond, S.P., Henderson, C., Harris, E., Vanhegan, S., Caswell, A., Poland, F., Smith, T., Penhale, B., Cross, J. and Fox, C. Alzheimer's Society Annual Conference, Manchester (June 2015) "An observational study of acute hospital care to inform a recovery pathway for hip-fracture patients with dementia" PDF 

Fox, C., Lambert, N., Poland, F., Cross, J., Sahota, O., Teale, E., Donell, S., Penhale, B., Smith, T., Hammond, S.P., Backhouse, T. and Varley, A. Alzheimer's Society Conference, Nottingham (July 2014) "Designing a hospital observational study involving lay researchers: the methodological challenges" PDF


The Research Team The Research Team

Principal Investigator

The Core Team

Additional contributors

  • Dr Nigel Lambert, Visitor, School of Health Sciences, UEA

  • Anna Varley, Research Associate in Process Evaluation, School of Health Sciences, UEA


  • Dr Pat Chung, School of Allied Health Professions, Canterbury Christ Church University



  • Professor Stephen Jackson, King’s College

  • Professor Opinder Sahota, University of Nottingham

  • Professor Martin Knapp, London School of Economics

  • Professor Alasdair MacLullich, University of Edinburgh

  • Professor Clive Ballard, King’s College London

  • Professor Justin Waring, Nottingham University

  • Professor John Young, Bradford Teaching Hospitals NHS Foundation Trust

  • Dr John Holmes, Leeds University

  • Professor Robert Howard, King's College London

  • Jo Walmsley, Norfolk and Norwich University Hospital NHS Foundation Trust