Home > Delirium, Hospitalization, Medical issues, Prevention > Dementia Patients Not Getting Right Kind of Care?

Dementia Patients Not Getting Right Kind of Care?

Image courtesy digidreamgrafix @http://www.freedigitalphotos.netThe other day, I wrote about how hospital patients in the U.S. are being bothered by what some consider to be excess nocturnal monitoring, possibly interfering with their recovery.  Today, I found an article that had to do with similar matters, but this time in the U.K.  This time, however, the concern revolves around hospitalized persons with dementia are not getting the proper kind of monitoring.

According to BBC News Health, the Healthcare Quality Partnership (HQP) commissioned a National Audit on Dementia, the first since its analysis of care in England and Wales in 2011.  This audit was led by the Royal College of Psychiatrists’ Centre for Quality Improvement, along with other organizations.  210 hospitals across England and Wales were included in the audit, which examined case notes for over 8,000 patients with dementia.  The results of this audit were critical of how infrequently these patient’s mental status was assessed, and how this information was shared with others involved in the patients’ care.

It is not unusual for people admitted to the hospital to become confused, for a variety of reasons — infection, medications, anesthesia, pain, and many more.  However, the audit discovered that only half of these patients had their mental status assessed.  And an even smaller number of people were tested to determine the cause of their delirium.  Not knowing the cause of a patient’s symptoms is very significant, when it comes to prescribing the proper course of treatment, and to ensuring safety and the best possible outcomes.

Another concern expressed by those conducting the audit was that a third of the hospitals included in the study did not adequately provide their staff with information about how to share information with the patients’ caregivers, or include them in their care.  Patients’ notes, as well as discharge information, were often lacking in information that would help other staff members communicate with them better.  Two in five of these hospitals did not provide dementia awareness information to new staff members.  Many of the hospitals’ staff members reported that they felt inadequate when it came to dealing with patients who have dementia.

The audit did reveal some positive information, however, since the last audit in December of 2011.  The number of prescriptions for antipsychotic drugs dropped by 10%, and it was presumed that staff members are utilizing more non-pharmaceutical methods for dealing with aggression and other behavioral problems.  Patients were more likely to receive a dietary analysis.  (Personally speaking, I can attest to the fact that many persons with dementia, if they have difficulty chewing their food or feel as if they may choke, will often show a sharp decrease in appetite — and, as a result, lose weight.)

The leader of the audit’s steering group, Professor Peter Crome, stated his pleasure in the improvements noted since the last audit.  However, he went on to note that there is still much progress that has yet to be made.  The head of policy and public affairs for the Alzheimer’s Society, George McNamara, was quoted as saying, “Given that people with dementia occupy a quarter of hospital beds, it is scandalous that improving dementia care is not a top priority for a number of hospital managers.”

It was noted that many of these patients are not being admitted to the hospital BECAUSE of their dementia.  However, its presence often serves as a factor which complicates their treatment for various reasons, whether it be an inability to cooperate with care or some other factor.  Because of this, many people end up coming out of the hospital in worse condition than when they were admitted.

The article went on to argue that hospitals needed to do a better job of training their staff to deal with their patients who have dementia.  Nurses who are adequately trained in this manner can go a long way toward helping to decrease the length of their patients’ hospital stays, work to prevent re-admissions, and serve as a guide for others on the hospital staff.

Care Services Minister Paul Burstow was quoted as saying that next year the government will be introducing a financial incentive to encourage hospitals to encourage hospitals to screen patients for dementia upon admission, and to plan care for these persons accordingly.  Staff levels and training also need to be looked at, he said.

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