All older people admitted to hospital must be assessed for memory function

12 July 2013

Professor Emma Reynish, Chair of the British Geriatrics Society Dementia and Similar Disorders Section comments in response to the findings of the second National Dementia Audit.

It is good to see that some progress has been made in improving hospital based dementia care since the last audit.   It is vital that all older people admitted to hospital receive an assessment of their memory function as part of a holistic evaluation of their needs so that they can be managed and treated appropriately.  The evidence shows that when frail older people are admitted to hospital they are 25% more likely to be alive and living independently at home when they are looked after in a specialist unit for older people which provides comprehensive assessment of their needs from the outset of their stay.

There is a high rate of delirium amongst the older population admitted to hospital, and it is most prevalent amongst those with pre-existing dementia.    This is of concern as people with delirium are more likely to stay in hospital longer, to be discharged to a care home after their stay and to be at greater risk of dying.  Prompt assessment of an individual’s memory function enables the early identification of delirium so that the right care can be put in place.

Assessment also leads to the identification of people with dementia – those with and without a formal diagnosis.  Individuals who have symptoms but no formal diagnosis can be referred onto dementia diagnostic pathways for timely diagnosis.  This is an essential part of how we can improve dementia diagnosis rates.

Furthermore, assessment of memory identifies all individuals with cognitive impairment (whether this is delirium, known dementia, or symptoms of dementia but no diagnosis) so that individual care plans in acute hospitals can be designed to meet people’s specific needs.  This leads to better communication, nutrition and orientation and makes it easier for health professionals to work in partnership with a patient’s caregivers.

Comments

Australia is in the process of developing a new national hospital standard the will require cognitive screening in all admissions for more than 24 hrs. My team from Ballarat in Victoria are the national lead for the roll out and re evaluation of the Dementia Care in Hospitals Program. This is an all of hospital ( clinical and non clinical staff) education and cognitive impairment awareness and communication education program linked to an over bedside alert ( an abstract graphic symbol) called the Cognitive Impairment Identifier. The program requires screening for CI because without it staff are not aware that they are asking of patients more than they can cognitively handle and this causes risk. Changes in adverse outcomes will be a key measure of the re evaluation. The Program is well supported by Alzheimer's Australia.

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