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Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings
Shadreck Mwale, Andy Northcott, Katie Featherstone. Sociology of Health & Illness, 2025-01-01
Topic: Risk, prevention and care in population studies
A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as 'wandering', we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and 'wander' the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.
Key findings
- A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required.
- Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others.
- The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.
Why it matters
This hospital ethnography examined how ethnicity, gender and social class affect the everyday care of people with dementia on NHS acute wards. It found that these intersecting factors influenced who was allowed to walk freely and who faced tighter ward rules, with institutional racism and attitudes to ageing shaping routine care.
Study details
- Evidence strengthLow
How this study scored 36/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Sociology of Health & Illness) |
| Journal's citation record | 2 / 4 | Sociology of Health & Illness: journal h-index 156 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 8 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 5.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Katie Featherstone: h-index 19 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | University of West London: institution h-index 117 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39749833) |
| Free to read | 2 / 2 | Free to read |
| Total | 36 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1111/1467-9566.13869
- PubMed: 39749833
- Original source →
- Free full text: Sociology of Health & Illness →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Mwale, S., Northcott, A., & Featherstone, K. (2025). Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings. Sociology of Health & Illness. https://doi.org/10.1111/1467-9566.13869
Vancouver
Mwale S, Northcott A, Featherstone K. Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings. Sociology of Health & Illness. 2025. doi:10.1111/1467-9566.13869. PMID: 39749833.
BibTeX
@article{mwale2025-39749833,
author = {Mwale, Shadreck and Northcott, Andy and Featherstone, Katie},
title = {{Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings}},
journal = {Sociology of Health \& Illness},
year = {2025},
doi = {10.1111/1467-9566.13869},
pmid = {39749833},
url = {https://doi.org/10.1111/1467-9566.13869}
}
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