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Improving dementia care in hospitals



Above: At today’s launch of the AIHW report, L-R, Glenn Rees, CEO Alzheimer’s Australia, Minister for Ageing, Mark Butler and AIHW CEO, David Kalisch.

“Our review suggests that the greatest potential benefits to patients lie in a combined approach by hospital, mental health, residential aged care and community services.  

“For example, simple measures taken in the hospital setting that appear to reduce length of stay for dementia patients and improve outcomes include staff training, discharge planning, dementia-friendly ward adaptations, and mental health and ageing liaison services”  Mr David Kalisch

By Keryn Curtis

A new report by the Australian Institute of Health and Welfare’s (AIHW) has confirmed what dementia experts and advocates have believed for some time – that people with dementia have longer stays in hospital and have higher costs of care than people in hospital who do not have dementia.

The report, entitled Dementia Care in Hospitals: costs and strategies, was formally released today at an event at Parliament House in Canberra by Alzheimer’s Australia’s National President and 2013 Australian of the Year, Ita Buttrose, the Minister for Mental Health and Ageing, Mark Butler and AIHW Director and CEO David Kalisch.

The report estimates the cost of caring for people with dementia in New South Wales* public hospitals, and presents a range of strategies and practices being implemented in Australia and internationally, that might improve the quality and cost efficiency of dementia care in hospitals. 

Looking at the average cost of hospital care for people who were admitted to hospital for the same reason, the report found the cost to be generally higher for people with dementia than for those without dementia ($7,720 compared with $5,010 per episode or approximately 50 per cent higher).   

It also showed that people with dementia stayed in hospital longer than people without dementia. 

The total costs of care in NSW public hospitals for patients who had dementia was estimated to be $462.9 million, of which around 35% ($162.5 million) may be associated with dementia.

Failures of identification and reporting

AIHW Director and CEO David Kalisch said providing care to people with dementia within a busy hospital ward could be challenging due to difficulties in communication and their often complex needs.   

“Identification and reporting of dementia is often poor in hospitals. For almost half of the episodes for people with dementia in this study, dementia was not recorded as either a principal or additional diagnosis,” Mr Kalisch said.

However, Mr Kalisch said there were several strategies highlighted in the report that could improve outcomes for people with dementia and reduce care costs.

“Our review suggests that the greatest potential benefits to patients lie in a combined approach by hospital, mental health, residential aged care and community services.  

“For example, simple measures taken in the hospital setting that appear to reduce length of stay for dementia patients and improve outcomes include staff training, discharge planning, dementia-friendly ward adaptations, and mental health and ageing liaison services,” Mr Kalisch said.

Urgent action needed

Glenn Rees, CEO of Alzheimer’s Australia, said that the AIHW report highlights the need for immediate action to improve care for people with dementia in hospitals and prevent unnecessary hospitalisations. 

“With currently more than 320,000 people with dementia in Australia, a number that is projected to increase to almost 900,000 by 2050, action needs to be taken now to improve the acute care system,” he said. 

“We urgently need new ways of identifying people who have dementia and ensuring that hospital staff is better supported to provide appropriate care. 

“We also need strategies to help people with dementia to stay out of hospital and to receive the care they need in the community. 

“Not only does a prolonged stay increase the risk of further complications, delay recovery and affect the persons physical and mental health, it also greatly increases the cost on our health system. 

“Better equipping our hospital systems to care for people with dementia, through supporting those programs, services and initiatives that are effective in improving the hospital experience could lead to better outcomes for people with dementia and their families.”

Not surprising

Ita Buttrose, National President of Alzheimer’s Australia and Australian of the Year 2013, said she wasn’t surprised by the report’s outcomes. 

“It confirms what has long worried us, that current approaches to the identification and provision of care for Australians with dementia are inadequate,” Ms Buttrose said. 

“A diagnosis of dementia has implications for other aspects of care and support. 

“It is distressing and unacceptable that so many people are slipping through the system without dementia being noted in their hospital records.

“As a society we would be concerned if a report was released indicating that cancer was not identified in 50 per cent of people with a cancer diagnosis who entered hospital. 

Drawing on firsthand experience with her father, Ms Buttrose said hospitals can be confusing for people with dementia, especially for those without family support. 

 “My father would have deteriorated greatly during his hospital stays had I not been there every day to help him,” she said. 

“For those without families to support them, a hospital stay can be an extremely frightening experience.” 

The report, Dementia Care in Hospitals: costs and strategies can be downloaded free as a PDF from the AIHW website.  A printed copy of the 109 page report can also be ordered from the same web page at a cost of $16.

* The study population used for the report included 21,000 people with dementia who had a completed hospital stay including at least one night in a NSW public hospital in 2006–07.



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