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Transforming dementia care in hospitals

Alzheimers Australia,dementia,hospital
Photo: Alzheimers Australia,dementia,hospital
Australian hospitals are failing to provide appropriate acute services for people living with dementia.

While one in four people living with dementia require hospital services each year, an Alzheimer’s Australia report shows the hospital environment is often an unsafe place for patients with dementia.

People living with dementia experience worse clinical outcomes compared to patients without dementia in hospitals - they are twice as likely to experience an adverse event such as falls, sepsis or pressure ulcers and three times more likely to experience fractures and delirium.

As a result, people with dementia stay in hospital almost twice as long as those without dementia, they face a five-fold increase in mortality rates and a higher likelihood of readmission.
Alzheimer’s Australia CEO Carol Bennett says while some of those issues are due to the nature of dementia, a lot of the evidence suggests that many of those differences are also largely attributable to the hospital environment.

“Hospitals are a very inhospitable environment in most cases for people with dementia,” she says.

Ms Bennett says improving the quality of acute care for people living with dementia will boost their health outcomes and deliver a more efficient use of our nation’s health care spending.

“The way that we support people with their dementia really does impact on the quality of life that they can have and the extent to which they manage the condition,” she says. “It really is that simple.

“If we can make the hospital environment more conducive to them having a better quality of life, that will make a huge difference to them, to their families, to their community, to the cost of care of dementia.

“There is a very strong argument that this is a key part of prevention, certainly as far as delaying the onset or the progression of the condition goes.”

The Dementia Care in the Acute Hospital Setting report highlights a range of issues and practical strategies to improve hospital care for people with dementia.

It says dementia often goes unrecognised or undocumented which contributes to the patient’s needs not being met, and calls for the identification of cognitive impairment.

“We know that 50 per cent of people with dementia don’t have their diagnosis documented during their hospital stay so it’s being missed and that’s really alarming,” Ms Bennett says.

Questions about cognitive impairment can be included on a pre-admission form or hospitals could require people at risk of cognitive impairment to be screened within 24 hours of admission, the report suggests.

“Once identified, people with cognitive impairment need different management and care during their stay in hospital, and appropriate discharge planning,” it states.

“The ideal approach to care for a person with cognitive impairment is for someone, such as a clinical nurse consultant in the emergency department, to start the journey with the person, ensure they have adequate support during their hospital stay and appropriate care.

“This allows for a discharge plan to be developed from the earliest stages. It is also an opportunity for the person with cognitive impairment and their carer to be informed about rehabilitation services as well as possible alternatives to admission.”

The report states hospital staff are not receiving the necessary training to provide quality care to people with dementia.

“For instance, it’s about knowing how to identify and communicate with someone who has dementia and how to respond to particular behaviours,” Ms Bennett says.

“Many people with dementia, particularly in the later stages, exhibit behaviours that can be quite severe so they need to understand the impact that that cognitive impairment has on a person’s ability to be involved in their own care as well.”

The report also calls for improving the engagement of carers of people with dementia.

Ms Bennett says carers should be viewed as an essential partner in the care of the patient during their hospital stay.

“Often the carers are excluded from consultations and decisions and really the carer will often provide real insight and enable better management of people who are in hospital settings.”

The report details strategies such as providing alternative care to antipsychotic drugs and reducing avoidable hospital admissions.

It also suggests adapting the physical hospital environment to reduce distractions and to help orientate patients with dementia in a bid to decrease their distress.

Ms Bennett says there are some common sense design approaches that can alleviate the discomfort people with dementia often feel during their hospital stay.

“We know when you’ve got floor coverings that are patterned, it often creates a level of confusion for people who have dementia around where they should step,” she says.

“For instance, if there’s a dark colour sitting on the background of a lighter colour they will see that as a hole in the floor - it’s understanding how a person with dementia would perceive their physical environment.

“If there’s too much white space in a bathroom, it can be very confusing for people to distinguish between different objects - the toilet, the basin, the shower and so you might need to provide some bright and solid colours that enable people to make that distinction.

“There is a science to this and it has been studied. We do now have a way of recommending physical environments that are more conducive to people with dementia.”

While a handful of health services nation-wide are leading the way in implementing initiatives to address the issues, Ms Bennett says much more needs to be done.

“We need to see some more sustained, consistent commitment and leadership by hospitals, by the health professions, by the government to ensure that we’re getting appropriate care for people in those settings.”

With almost 343,000 people in Australia now living with dementia and that number expected to exceed 900,000 by 2050, improving dementia care in hospitals is vital, Ms Bennett says.

“Our hospitals are going to be increasingly filled with people with dementia,” she says.

“We assume that people will just fit in to the environments that we provide and when it comes to people with dementia quite clearly they are not comfortable in those environments.

“It creates problems because if you’re sent to hospital for a range of health conditions you might find you end up with even more problems and, in fact, that’s what usually happens.

“If people want to stay in the community, it’s important that we enable them to prolong or delay the onset of the more severe symptoms of dementia so that they can maintain a quality of life in the community - where most people really want to be.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords