Hospitals fall short in care for dementia

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A “significant improvement” is needed in the way hospitals deliver care to people with dementia, according to a report.

While hospitals say they have policies in place, these are not always followed and simple steps are not taken that could lessen the distress to patients.

The study said the encounter between staff and patients “is mainly task-related and delivered in a largely impersonal manner” while the hospital environment is “often impersonal”.

Staff do not always greet or talk to patients, explain what they were doing or offer choice. Sometimes they do not respond to patient requests for help.

The National Audit of Dementia, which covers England and Wales, found only six per cent of people with dementia had their level of cognitive impairment measured on admission and discharge, while only 43 per cent of case notes showed patients had a mental status test. This is despite 75 per cent of hospitals saying they had a procedure for it.

Only nine per cent of casenotes showed patients being screened for delirium, despite 33 per cent of hospitals saying they had policies in place.

People with dementia can become agitated, distressed or aggressive while in hospital.

NHS guidance says the use of antipsychotics to control these symptoms should be a last resort, but many hospitals still use them.

The audit found 28 per cent of people with dementia received antipsychotic medication in the hospital, of which 12 per cent were newly-prescribed the drugs while in there.

The reasons for these prescriptions were not recorded in 18 per cent of these cases, while less than half of staff felt properly trained in dealing with challenging behaviour. More than half (59 per cent) of wards said personal items were not put where dementia patients could see them for reassurance.

And only 26 per cent of casenotes showed an assessment of functioning (such as basic activities of daily living, activity/exercise status, gait and balance), despite it being included in 84 per cent of hospital procedures.

While 96 per cent of hospital policies said they assessed nutritional status, only 70 per cent of casenotes said it had been done.

Only 74 per cent of wards had a system to ensure enough staff to help dementia patients eat at mealtimes and only five per cent of hospitals had mandatory training in awareness of dementia for all staff.

Overall, less than a third (32 per cent) of staff said they had sufficient training or learning in dementia care.

The report comes after figures yesterday showed emergency hospital admissions for people with dementia have increased by 12 per cent in the last five years.

In 2006/7 there were 17,245 emergency admissions – in 2010/11 there were more than 2,000 more.

Professor Peter Crome, chair of the national audit of dementia steering group, said: “This report provides further concrete evidence that the care of patients with dementia in hospital is in need of a radical shake-up.

“We have a provided a number of recommendations that if implemented will enable patients and their families to have confidence in their hospital treatment.

“It is good to see that several hospitals have responded to the results of the interim findings with programmes of quality improvement.”