Early diagnosis critical in dementia

Above: Prof Graham Stokes -Global Director of Dementia Care, Bupa

By Keryn Curtis

A dramatic shift in attitudes to early diagnosis of dementia is needed in Australia to ensure less emergency hospital admissions and better quality of life outcomes for people with dementia, according to a visiting international dementia expert.

Visiting Global Director of Dementia Care for the health insurance and aged care group, Bupa, Professor Graham Stokes, warned a meeting of health professionals last week that the acute hospital sector is under strain from the increasing number of patients admitted with dementia.

Professor Stokes said around 30 per cent of hospital beds are occupied by people with dementia and their length of stay is twice as long as the average patient.  He said more needs to be done to prevent these people ending up in the hospital system.

“Hospital is the absolutely worse place for someone with dementia. They often resist treatment and are difficult to manage because they don’t understand where they are or what is happening to them,” said Professor Stokes. 

Professor Stokes said that greater emphasis should be placed on recognising signs of the early stages of the disease and providing these people and their families with appropriate management plans to support their quality of life and prevent hospitalisation.

He said being in hospital was a very distressing time, both for the person with dementia and the family and that it was commonplace for people with dementia in hospitals to be given psychotropic drugs.  

“The sedation may be necessary to relieve their anxiety, but it is anxiety induced by the foreign environment, not the severity of their dementia.”

“Only one-third of people with dementia, who are admitted to hospital, ever return home.  The majority enter aged care, and once psychotropic drugs have been prescribed by a hospital physician, it is very difficult to cease the medication,” said Professor Stokes.  

He said early diagnosis and the provision of better support for people with dementia in their homes and the community is a crucial step in keeping them out of the hospital system.

“People living with dementia tend to struggle on, masking their symptoms until at some point they have a critical incident that lands them in hospital, where their problems unravel.

“Less than 40 per cent of people living with dementia in the community are diagnosed and of this group few receive sufficient support,” he said.

Multiple barriers to diagnosis

Professor Stokes said there were a number of barriers that needed to be addressed to enable early diagnosis of dementia.

“The first is that we have an ageist society so we don’t become alarmed when people become forgetful. We think it’s just a normal part of growing old.

“Also there is still a lot of stigma about dementia and most dementia services unfortunately are wrapped up with psychiatric facilities.  So the probability is that it is will be a psychiatrist, rather than a neurologist, who the person will be referred to.

“The third thing is isolation.  Often it is women who are widowed and have some chronic health problems so they’re not out and about as much and they become isolated and so they are slowly dementing in private,” said Professor Stokes.

Another problem, he said, was that without good options for support, GPs were often quite sceptical of the value of diagnosis for early stage dementia.  

“There’s a certain therapeutic nihilism on their part.  Yes, we have some drugs that can help for a year or two but generally they don’t trust what will happen to the diagnosis. In all high-income countries, including Australia, we still only diagnose the minority of people.”

But according to Professor Stokes, even those people who are diagnosed early and dispatched to the GP, often tend to just ‘float away’.

“People disappear back into their lives and we don’t see the changes over time that are incremental. Slowly, people are worn out and then it reaches a crisis point and it could be neglect, family breakdown or a fall or whatever.  It’s an unfortunate story for many who get a diagnosis.

“So they are very practical, pragmatic issues that GPs are facing. People expect to have treatment and support with a diagnosis but they won’t get it.”

Prof Stokes says keeping people with dementia out of the hospital system must be a priority.

“We’re not doing enough to diagnose dementia during the early stages of the disease and we fail to provide these people with appropriate management plans to support their quality of life and prevent hospitalisation,” he said.