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Acute care needs dementia culture change: report


Dementia care in the acute hospital setting report coverIdentifying and managing dementia from the outset, involving the family carer, and training staff to better communicate with people with dementia, are among six strategies to improve acute care for people living with dementia proposed in a report launched today.

The Alzheimer’s Australia paper said inadequate screening, lack of training and a hospital culture that labelled people with dementia as difficult contradicted patients’ best interests.

The report has highlighted that people with dementia were more likely to experience falls, sepsis, pressure ulcers, fractures and delirium while in hospital, which resulted in a five-fold increase in mortality rates for hospital patients with dementia.

It is calling for education and cultural change in hospitals and a sustained commitment from policy makers, senior management and healthcare professionals to improve hospital outcomes for patients with dementia.

The issues and strategies detailed in the report stem from discussions among leading dementia researchers and experts at the Dementia Care in Hospitals Symposium held in Sydney in April.

Strategies proposed in the report to improve outcomes for people with dementia:

  1. Identify and manage dementia at hospital admission and plan for discharge from the outset
  2. Involve family carers in the care and support of patients
  3. Train staff to better understand dementia and communicate more effectively with people with dementia
  4. Use alternatives, such as psychosocial interventions, to the use of antipsychotic medication and sedatives
  5. Adapt the hospital physical environment to reduce distractions and help orientate patients with dementia
  6. Reduce avoidable hospital admissions.
Successful programs

The report features examples of successful programs including the emergency department based Aged Care Services in Emergency Team (ASET) in NSW, which can help with screening and assessing cognitive impairment, determining care needs and planning and ensuring the person has a seamless transition between care facilities

Also operating in some NSW hospitals is the TOP5 Program, which enables carers to share five care strategies for the person with dementia for health care professionals to use in a bid to provide better quality care.

Victoria’s Dementia Care in Hospitals Program (DCHP), which combines screening for cognitive impairment with hospital wide staff training and a visual bedside symbol identifying the patient has a cognitive impairment, was also highlighted.

The report also commended the Federal Government’s aged care reform commitment of $40 million over five years to improve hospitals for people with dementia, which has already funded the Dementia Training Study Centres to improve the physical design of hospitals through training and audits, and the Australian Commission on Safety and Quality in Health Care to develop a dementia-specific resource for hospitals to improve care in the context of national standards.

However, it said while this funding was a crucial first step and there were some successful programs improving acute care for people with dementia, more was needed to achieve the cultural change required.


Glenn Rees

Systemic reform

Echoing this, Alzheimer’s Australia CEO Glenn Rees said some of that reform funding could go towards implementing these strategies but he stressed it was just as much a matter of culture, attitude and planning as it was money.

“It is about making the hospital system aware in an ongoing way of dementia and building it into their plans and their thinking.

“Some of that might take money some of that might not. If you are building a new hospital, then why not plan for an environment for older people and those with cognitive impairment,” Mr Rees told Australian Ageing Agenda.

He said systemic reform was the most important element for achieving change, which made the work to develop national standards promising.

“It is really good when you see some wonderful examples of individual hospitals providing care and doing well in looking after people with dementia but I think it is even better when you sense that there is a way of actually improving hospitals in a systemic way,” he said.

If those system changes through national standards along with strategies to promote early recognition and working with carers took off in the next couple of years we would start to see some improvements in the quality of care, which is encouraging, he said.

The Australian Commission on Safety and Quality in Health Care has developed a draft handbook and the final resource is expected mid-2014.

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