Doctor: Like HIV, dementia will become more manageable

The fear associated with a diagnosis of dementia is like the fear once associated with a diagnosis of HIV — but like HIV, it should become more manageable in the future.

That’s according to emergency medicine consultant Chris Luke, who was addressing a conference in Cork on Innovations in Dementia Care.

Dr Luke said: “HIV was once a death sentence, and it’s the same with dementia at the moment, but in the near future, we will manage dementia like a chronic illness.”

In a talk entitled ‘Improving the Dementia Experience in the Emergency Department: A Personal View’, Dr Luke said a major increase in emergency department (ED) attendances by the elderly, many of whom are affected by dementia, presented considerable challenges in already overcrowded situations.

Dr Luke, who works in the Mercy University Hospital and Cork University Hospital, said one of the “most dramatic things” that has happened in emergency medicine in the recent past is the rise in the number of patients who have be admitted to hospital.

“Our conversion rate — which is the number who pitch up, compared to those who are admitted — has suddenly spiralled in the last 12 months,” he said.

“Where 20% of our daily presentations were being admitted five years ago, now it’s up to 40% some days, which is a staggering revelation and a staggering challenge in terms of resources. And of course 20% of our patients and rising, are over 65.”

When dealing with patients with dementia in the ED, Dr Luke said staff should “first and foremost, be kind”.

He said sometimes patients arriving at the ED had to wait a couple of hours to get out of the ambulance “so we have a serious problem with logistics”.

He agreed with consultant geriatrician Ciara McGlade, who also addressed the conference, hosted by St Luke’s Care Home, Mahon, about the need for advanced care planning for the elderly, as a means of giving them more control over future care, in the event of developing dementia.

He said elderly people with advanced dementia were “terrified of having their ribs crunched like a barbecued chicken wing” during resuscitation attempts that were “pointless and absurd”.

“People are terrified of death, which is a tragedy in Ireland of all places, where we’ve been in love with death for years,” he said.

“We should embrace it, we should realise it’s part of the normal organic cycle.”

Dr Luke said elderly people with dementia were often terrified of “being robbed by their children, being muscled out of the family home”.

Dr McGlade gave an example of an elderly woman with dementia whose family made repeated attempts to have her admitted to a nursing home.

She was a smoker and they said there were burn marks on her carpets and clothes from cigarettes and it was for her own safety.

However, when the woman was assessed, Dr McGlade said she was “well able to weigh up the pros and cons” and gave up smoking.

Six months later, the family were back saying the woman needed nursing home care because she could not use the phone to call for help. They had given her a mobile phone. When a landline was installed, the woman was able to cope.

On the third attempt, the family said they were abdicating all responsibility for their mother and her safety was on the HSE’s head.

“We asked her what she wanted,” said Dr McGlade. “She wanted to go home. She knew she would have difficulty managing, but asked what help she could get. Two years down the line, she’s still at home. 

"It’s about context and choices and consequences. A lot of this is about maximising freedom and minimising risk.”

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