Hospitals' dementia care criticised

 

A "significant improvement" is needed in the way hospitals deliver care to people with dementia, according to a report.

While hospitals say they have policies in place, these are not always followed and simple steps are not taken that could lessen the distress to patients, most of whom are elderly.

The study said the encounter between staff and patients "is mainly task-related and delivered in a largely impersonal manner" while the hospital environment is "often impersonal".

Staff do not always greet or talk to patients during care, explaining what they were doing or offering choice. Sometimes they do not respond to patient requests for help.

The National Audit of Dementia, which covers England and Wales, found only 6% of people with dementia had their level of cognitive impairment measured on admission and discharge, while only 43% of case notes showed patients had a mental status test despite 75% of hospitals saying they had a procedure for it.

Only 9% of case notes showed patients being screened for delirium, despite 33% of hospitals saying they had policies in place.

People with dementia can become agitated, distressed or aggressive while in hospital due to the hospital environment, aspects of care, illness or injury, or their dementia getting worse.

NHS guidance says the use of antipsychotics to control these symptoms should be a last resort, but many hospitals still use them.

The audit found 28% of people with dementia received antipsychotic medication in the hospital, of which 12% were newly-prescribed the drugs while in there.

The reasons for these prescriptions were not recorded in 18% of these cases, while less than half of staff felt properly trained in dealing with challenging behaviour.

More than half (59%) of wards said personal items (such as family photographs or cards) were not put where dementia patients could see them for reassurance.

And only 26% of casenotes showed an assessment of functioning (such as basic activities of daily living, activity/exercise status, gait and balance), despite it being included in 84% of hospital procedures.

While 96% of hospital policies said they assessed nutritional status, only 70% of casenotes showed this had been done.

Furthermore, 19% of casenotes did not show the patient was asked about any continence needs and 24% did not show that the patient was asked about pain.

Only 74% of wards had a system to ensure enough staff to help dementia patients eat at mealtimes and only 5% of hospitals had mandatory training in awareness of dementia for all staff.

Overall, less than a third (32%) of staff said they had sufficient training or learning in dementia care.

Recommendations in the report include providing basic dementia training for all staff, with some ward staff receiving higher level training.

A senior clinical lead for dementia should also be in place in each hospital, with dementia champions in each department and at ward level.

The report comes after figures yesterday showed emergency hospital admissions for people with dementia have increased by 12% in the last five years.

In 2006/7 there were 17,245 emergency admissions - in 2010/11 there were more than 2,000 more.

Professor Peter Crome, chair of the national audit of dementia steering group, said: "This report provides further concrete evidence that the care of patients with dementia in hospital is in need of a radical shake-up.

"We have a provided a number of recommendations that if implemented will enable patients and their families to have confidence in their hospital treatment.

"It is good to see that several hospitals have responded to the results of the interim findings with programmes of quality improvement."

Royal College of Nursing (RCN) chief executive, Dr Peter Carter said: "It is extremely worrying that two thirds of staff found that their training and development was not sufficient.

"It is essential that all staff are supported through training, education and leadership so that they are able to provide skilled, knowledgeable care to people with dementia.

"Equally, each nurse is personally accountable for their own practice and must act promptly to raise concerns if staffing levels or other pressures are getting in the way of delivering good care."

Jeremy Hughes, chief executive of the Alzheimer's Society, said: "This shocking report proves once again that we urgently need a radical shake-up of hospital care.

"Given that people with dementia occupy a quarter of hospital beds and that many leave in worse health than when they were admitted, it is unacceptable that training in dementia care is not the norm."

Care services minister Paul Burstow said: "We set this audit up to put dementia care in hospital in the spotlight.

"It has found some excellent practice, but it has revealed far too many hospitals failing to put in place dementia friendly care."

He added: "Improving dementia care is a priority for this Government.

"That is why we are putting in place a new financial incentive for hospitals that identify patients at risk so they get the specialised care they need."

PA

PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
News
REX/Eye Candy
science
News
A photo of Charles Belk being detained by police on Friday 22 August
news
News
i100
Sport
Alexis Sanchez celebrates after scoring his first goal for Arsenal in the Champions League qualifier against Besiktas
sportChilean's first goal for the club secures place in draw for Champions League group stages
Arts and Entertainment
Amis: 'The racial situation in the US is as bad as it’s been since the Civil War'
booksAuthor says he might come back across Atlantic after all
Extras
indybest
Life and Style
Google Doodle celebrates the 200th birthday of Irish writer Sheridan Le Fanu
tech
Arts and Entertainment
Vinyl demand: a factory making the old-style discs
musicManufacturers are struggling to keep up with the resurgence in vinyl
News
i100
News
In Eternal Sunshine of the Spotless Mind Jim Carrey and Kate Winslett medically erase each other from their memories
scienceTechnique successfully used to ‘reverse’ bad memories in rodents could be used on trauma victims
Arts and Entertainment
Singer Pixie Lott will take part in Strictly Come Dancing 2014, the BBC has confirmed
tv
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    C# Developer (C#, ASP.NET Developer, SQL, MVC, WPF, Real-Time F

    £40000 - £48000 per annum + benefits+bonus+package: Harrington Starr: C# Devel...

    C# Swift Payment Developer (C#, ASP.NET, .NET, MVC, Authorize.N

    £45000 - £60000 per annum + benefits+bonus+package: Harrington Starr: C# Swift...

    Front-End Developer (JavaScript, HTML5, CSS3, C#, GUI)

    £55000 - £70000 per annum + Benefits + Bonus: Harrington Starr: Front-End Deve...

    Graduate C# Developer (.NET, WPF, SQL, Agile, C++) - London

    £30000 - £40000 per annum + Benefits + Bonus: Harrington Starr: Graduate C# De...

    Day In a Page

    Israel-Gaza conflict: No victory for Israel despite weeks of death and devastation

    Robert Fisk: No victory for Israel despite weeks of devastation

    Palestinians have won: they are still in Gaza, and Hamas is still there
    Mary Beard writes character reference for Twitter troll who called her a 'slut'

    Unlikely friends: Mary Beard and the troll who called her a ‘filthy old slut’

    The Cambridge University classicist even wrote the student a character reference
    America’s new apartheid: Prosperous white districts are choosing to break away from black cities and go it alone

    America’s new apartheid

    Prosperous white districts are choosing to break away from black cities and go it alone
    Amazon is buying Twitch for £600m - but why do people want to watch others playing Xbox?

    What is the appeal of Twitch?

    Amazon is buying the video-game-themed online streaming site for £600m - but why do people want to watch others playing Xbox?
    Tip-tapping typewriters, ripe pongs and slides in the office: Bosses are inventing surprising ways of making us work harder

    How bosses are making us work harder

    As it is revealed that one newspaper office pumps out the sound of typewriters to increase productivity, Gillian Orr explores the other devices designed to motivate staff
    Manufacturers are struggling to keep up with the resurgence in vinyl records

    Hard pressed: Resurgence in vinyl records

    As the resurgence in vinyl records continues, manufacturers and their outdated machinery are struggling to keep up with the demand
    Tony Jordan: 'I turned down the chance to research Charles Dickens for a TV series nine times ... then I found a kindred spirit'

    A tale of two writers

    Offered the chance to research Charles Dickens for a TV series, Tony Jordan turned it down. Nine times. The man behind EastEnders and Life on Mars didn’t feel right for the job. Finally, he gave in - and found an unexpected kindred spirit
    Could a later start to the school day be the most useful educational reform of all?

    Should pupils get a lie in?

    Doctors want a later start to the school day so that pupils can sleep later. Not because teenagers are lazy, explains Simon Usborne - it's all down to their circadian rhythms
    Prepare for Jewish jokes – as Jewish comedians get their own festival

    Prepare for Jewish jokes...

    ... as Jewish comedians get their own festival
    SJ Watson: 'I still can't quite believe that Before I Go to Sleep started in my head'

    A dream come true for SJ Watson

    Watson was working part time in the NHS when his debut novel, Before I Go to Sleep, became a bestseller. Now it's a Hollywood movie, too. Here he recalls the whirlwind journey from children’s ward to A-list film set
    10 best cycling bags for commuters

    10 best cycling bags for commuters

    Gear up for next week’s National Cycle to Work day with one of these practical backpacks and messenger bags
    Paul Scholes: Three at the back isn’t working yet but given time I’m hopeful Louis van Gaal can rebuild Manchester United

    Paul Scholes column

    Three at the back isn’t working yet but given time I’m hopeful Louis van Gaal can rebuild Manchester United
    Kate Bush, Hammersmith Apollo music review: A preamble, then a coup de théâtre - and suddenly the long wait felt worth it

    Kate Bush shows a voice untroubled by time

    A preamble, then a coup de théâtre - and suddenly the long wait felt worth it
    Robot sheepdog technology could be used to save people from burning buildings

    The science of herding is cracked

    Mathematical model would allow robots to be programmed to control crowds and save people from burning buildings
    Tyrant: Is the world ready for a Middle Eastern 'Dallas'?

    This tyrant doesn’t rule

    It’s billed as a Middle Eastern ‘Dallas’, so why does Fox’s new drama have a white British star?