Australia’s peak dementia advocacy body is calling for mandatory dementia training for all hospital staff including those in catering and cleaning roles after government statistics showed almost 95,000 hospitalisations of people with dementia in a year.
One in five of those admissions ended up in residential care.
Dementia Australia says previous research shows people living with dementia are twice as likely to be admitted to hospital and up to three times more likely to have an adverse event in hospital.
In a report released on the back of new figures from the Australian Institute of Health and Welfare (AIHW), Dementia Australia says despite the introduction of cognition and delirium standards, dementia training for hospital staff remains inconsistent and there there’s still poor awareness around patient support and enabling environments.
“Admission processes, emergency protocols (including security arrangements and management of code ‘red’ situations involving people with dementia) and day-to-day care are typically not supportive of people with cognitive impairment,” Dementia Australia says.
It recommends that “hospitals provide mandatory training for all hospital staff including people in clinical, administration, catering and cleaning roles”.
Dementia Australia also wants to see hospitals to adhere to dementia-friendly design standards, including orientation cues and quiet spaces, as well as improvements in the way patients are transferred from hospital to aged care facilities.
Hospitals not good for people with dementia
Evidence suggests hospitals aren’t good places for people with dementia, Dementia Australia says in its response to the AIHW report. Confusion, disorientation and distress related to the unfamiliar hospital environment can exacerbate symptoms and result in cognitive decline.
Dementia also increases the risk of a patient developing delirium five-fold, and patients with cognitive issues are at greater risk of complications, pressure injuries, prolonged stays, premature admission to residential care and death.
Dementia Australia is also concerned that almost a third of people with dementia remain within the hospital system “rather than moving to a more supportive or familiar environment” and that almost 20 per cent move to residential aged care, “presumably in unplanned circumstances”.
The AIHW report found the average length of stay for people awaiting placement in an aged care facility was 21 days, nearly double that for people discharged to their homes.
The additional length of stay could worsen symptoms of dementia and potentially lead to a decline in functioning, Dementia Australia says.
Delirium a significant factor
The AIHW found that in 2016-17 there were 94,800 hospitalisations with a least one diagnosis of dementia. Dementia was the principal diagnosis in 22 per cent of these hospitalisations.
The average length of stay for people with dementia was 13 days, compared to the average length of stay for all hospitalisations in 2017-18 of 2.8 days.
Indigenous Australians were 1.5 times as likely to be hospitalised with dementia compared to the rest of the population.
The AIHW found that the rate of dementia hospitalisations decreased by almost a quarter between 2006-07 and 2016-17 but the rate of hospitalisations for delirium on top of dementia increased by over 400 per cent during the same period.
“Unfortunately this indicates that delirium is a significant factor in the hospitalisation of people with dementia and Dementia Australia is concerned that hospital staff are not able to appropriately respond to people with dementia who have a superimposed delirium,” the peak said.
Read the full AIHW report here.