‘No standardised approach to dementia care’

The quality of dementia care in Ireland’s acute hospitals is highly variable, with poor access to many diagnostic and support services.

‘No standardised approach to dementia care’

The first-ever national audit of services for patients with dementia has revealed a lack of standardised approach by Irish hospitals to the treatment of people with such mental health problems.

The major study — which audited 35 acute hospitals across the Republic — found there is inadequate assessment of many patients with dementia on their admission to hospital.

Furthermore, issues relating to a person’s condition which are discovered during their hospital stay are often not highlighted on their discharge for future care.

One of the report’s main authors, Dr Suzanne Timmons, consultant geriatrician at the Mercy University Hospital and University College Cork’s Centre for Gerontology and Rehabilitation, said the audit’s findings were “unfortunate, but not unexpected”.

Dr Timmons said the aim of the project was to encourage hospital staff to change their practices and culture in relation to dementia-related services.

She stressed the importance of standardised care, because most people with dementia were more anxious about being in an unfamiliar environment than other types of hospital patients.

“The training of staff has not been prioritised in hospitals. No hospital had mandatory training for staff in dementia awareness,” said Dr Timmons.

Hospital patients in Ireland with dementia are twice as likely to be prescribed a powerful anti- psychotic as similar patients in Britain, the study found.

“It shouldn’t be used as a first line. It should be used as a last resort,” said Dr Timmons.

She added that such a finding signalled that healthcare staff in Irish hospitals did not feel equipped to deal with some patients with dementia.

The report also expressed concern that there is no regular screening for delirium among patients with dementia.

The audit — which was carried out in partnership by UCC, Trinity College Dublin, and the HSE — involved interviews with senior hospital managers, geriatricians, the clinical nurse managers of 77 wards, as well as a review of the health records of 660 patients with dementia.

The work was funded by Atlantic Philanthropies and the Meath Foundation.

The records of patients revealed that actual treatment was less than the stated practice by senior managers and clinicians.

For example, they claimed nutritional assessments were routinely performed on 97% of patients but records showed the true figure was 76%. Similarly, staff claimed 88% of patients had their body mass index routinely recorded but records showed it was just 39%.

It is estimated that dementia costs the State up to €21m per annum with up to a quarter of all hospital patients in a typical general hospital suffering from dementia at any one time.

Among the 45 recommendations contained in the report is one for all hospital staff to have basic level training in dementia awareness.

It also strongly argues for the screening of patients with dementia for delirium upon admission and afterwards on a regular basis.

A national dementia strategy is due to be published soon which is expected to set out procedures and practices for the treatment of dementia in acute hospitals.

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