Alarm at levels of dementia awareness in Irish hospitals

One of the most striking findings from the National Audit of Dementia Care in Acute Hospitals 2014 report was that only 6 per cent of hospitals include dementia-awareness on their staff induction programmes, and none of the 35 Irish hospitals in the study has compulsory dementia-awareness education for staff.

"It has to become mandatory training," says Dr Sean Kennelly, a geriatrician at Tallaght hospital in Dublin. "If you don't get the first step – identifying a very vulnerable person who is likely to run into problems during their hospital stay at the front door of the hospital – then it's likely nothing else is going to happen to assist their care.

“Let’s say you take two older people who come into hospital with a chest infection; one with dementia, one without dementia. If you take all the other factors out of it, the fact that you have dementia probably means you’re going to be a minimum of four more days in hospital.

“When you consider that chest infections – along with chest pains – are our most common causes of medical admission, that is a huge number of extra bed days. The reason is that it is often not identified that a person has dementia until they are discharged.”

Screening standards

Kennelly advocates training across the hospital environment, including doctors, nurses, healthcare assistants, X-ray staff, and the porters who ferry patients between departments.

He also notes that two or three hospitals in the State have implemented standard screening of all older patients with memory tests when they’re coming into emergency departments. This can be particularly disorientating for people with dementia, as often the patients will have no family present, they might have poor hearing, and staff might not have their medical history to hand.

“A lot of the time, the patient might [experience] paranoia. For older people who would get acutely confused – who might have been removed from their home, who could be sick with an infection – they may perceive they’re not in a hospital, they’ve been brought to a police station or that somebody is conspiring against them. They may feel their son or daughter, or whoever, is trying to harm them. They misinterpret a huge amount of action.

“By our nature in hospitals, we’re very comfortable dealing with the biology, with heart rates, with a person who has an infection. We delve straight into that. Often, we forget to talk to somebody who is confused and who doesn’t understand why somebody is coming out of leftfield and sticking them with a needle.”

There are about 48,000 people living with dementia in Ireland, according to the Alzheimer Society of Ireland. The majority of them – about 63 per cent – live at home, which means they’re being cared for by family members, many of whom might have given up their jobs.

“The training for family care is very important,” says Tina Leonard, head of advocacy at the Alzheimer Society of Ireland.

“They need an understanding of the illness, and what changes are going to come about in the behaviour or memory of their loved ones. The person is still the same person, but the person’s behaviour might change.

“There are simple strategies they can use, for example, by putting a note up on the wall – ‘Today is Monday’ – or a Post-It on the oven in case you’re taking out something hot without oven gloves. You might suggest to your spouse to use a notebook to write things down because you might forget in a little while what you want to say.”

Co-ordinating research

Dr

Kate Irving

, who is co-ordinating research at Dublin City University (DCU) into society’s approach to dementia, cites a dementia-friendly initiative that is being implemented around shops and eateries in Co Tipperary.

“The shops are in the middle of training so people with dementia and their families can go in to them and expect a certain amount of understanding.”

In addition to public awareness, the Alzheimer Society of Ireland has identified training of GPs about dementia as a priority. “In the past, we’ve had a very paternalistic medical approach,” says Leonard. “Where a doctor says, ‘Oh, I’m not going to tell the person. There is no cure. We’ll just leave it,’ until a time when that person has cognitive disability, and doesn’t understand what’s going on.

“We promote timely diagnosis because if a person is diagnosed early in their journey, they can put plans in place for their future.”

Suzanne Cahill, associate professor at the Dementia Services Information and Development Centre in St James’s Hospital, agrees with Leonard about the need to train GPs about dementia.

“We did a major survey of 600 GPs, probably about 10 years ago, and a key finding was that GPs had no dementia training in their undergraduate programme, and about 83 per cent welcomed training.

“Even though that survey was 10 years ago, nothing has happened by way of national training of GPs for dementia since then.

“The real difficulty with getting GPs to undertake training is that they’re busy people. There is no financial incentive in Ireland for GPs to diagnose dementia.

“In other countries, there are rewards put in place – they’re financially reimbursed – if people [establish] a register of people with dementia. It’s another barrier for GPs getting involved here.”