Dementia care: improvements needed

The National Audit of Dementia was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement in partnership with other organisations. The main audit looked at data collected from 210 hospitals across England and Wales. Ward level data was collected from a sample of 145 wards across 55 hospitals. This included 2,211 staff questionnaires, and 105 observations of care on the ward, carried out by hospital staff. It brings together key recommendations from five major policy documents1-5 and demonstrates that these broadly align, and identifies that there is a ‘road map’ for the components of quality care. The audit identified that, although the majority of wards do meet basic safety requirements, many had not addressed simple measures that could lessen the distress caused to dementia patients by an unfamiliar and confusing hospital environment. The report also found that staff training was lacking, with less than one-third of staff surveyed believing that their training and development in dementia care was sufficient. Observations of care carried out for the audit found that care is often delivered in an impersonal manner, by staff who did not fully understand the needs of patients. Considering that there are around 750,000 people with dementia in the UK, with this figure forecast to increase to over a million by 2021, this is an issue that must be addressed. Although hospital care can offer little in the way of treatment for dementia, patients with dementia often have additional health or behavioural problems that increase their risk of requiring admission to hospital. For example, they often become more confused and distressed. They are at risk of falling, acquiring an infection or becoming institutionalised and less able to care for themselves at home. The main reasons for admission to hospital for people with dementia are because of a fall (14%) or fracture (12%), urinary tract infection (9%), chest infection (7%) and transient ischaemic attacks (7%).6

The cost of care

There is evidence to show that the cost of care in the acute environment is greater for patients with dementia. A National Audit Office report7 found that for people with dementia the average duration of stay in hospital after a hip fracture was 43 days, compared with 26 days in patients who are psychiatrically well. In its ‘Counting the cost’ report (2009),6 the Alzheimer’s Society DEMHOS study data shows that 25% to 35% of patients with dementia admitted with these problems remained in hospital for over one month. Evidence collected for the report demonstrates a lack of leadership both at Trust/Health Board level and at hospital level, in terms of identifying champions and leads and identifying required resources. The report authors suggest that Trust Boards/Health Boards require better intelligence and information relating to the admissions, care, treating and discharge of people with dementia to enable the necessary improvements to processes and overall governance to be made to consistently deliver a good standard of care throughout the hospital.