Improving Person Centred Care for People with a Cognitive Impairment

2. Improving Person Centred Care for People with a Cognitive Impairment

3. Why is this issue so important? Currently there are 82,000 people with dementia in Scotland (projected to double in the next 25 years) One infour of all general hospital beds in UK are occupied by a person over 65 years who has dementia (Alzheimer Society 2009) Having dementia or delirium is a predictor of poor outcomes for older people using hospital services It’s a personal issue for many of us, just now, and in the future

4. Jim’s Story Retired Joiner Married to Mary 2 children and 6 grandchildren Keen bowler Interested in politics Enjoys gardening and his allotment

5. Jim’s story – scenario one Admitted via A&E with chest pain The fact that he has a diagnosis of dementia is not established. Limited information is requested /obtained from Mary and his wider family. Jim is admitted to the medical receiving ward for “further tests”. Jim becomes very anxious and disorientated in the new environment – he is then moved to three different wards His community mental health nurse is not contacted. Staff understanding and tolerance of dementia is poor. Jim gets quite agitated – staff identify him as at risk of “wandering and aggression”.

6. Jim’s story – scenario 1 Jim is commenced on psychotropic medication to “calm him down”. The sedative effects lead to Jim having reduced mobility and being at risk of falls, increased incontinence, disturbed sleep pattern and being less able to take meals and drinks. Jim is catheterised due to increased incontinence – this leads to a urinary tract infection. Jim develops delirium, leading to increased dependency and confusion. Jim suffers a number of falls; while no serious injuries are sustained, he is now covered in bruises and continues to lose weight. The staff have now put Jim on one to one observation level to manage “risk”. After a 35 day stay, Jim is transferred to a care home as the staff and Mary feel he will no longer be able to be supported at home.

7. Risks of being in hospital • Increase in mortality • Increased length of stay • Increase in adverse drug reactions • Early admission to long term care • Incidents of new incontinence which becomes permanent • Poorer cognitive functioning • Increased levels of dependency on discharge • More likely to be prescribed anti psychotic drugs (Counting the Cost - Alzheimer’s Society 2009)

8. Jim’s Story – Scenario 2 When Jim is admitted Full Information about Jim’s dementia and how he currently copes was obtained from Mary and other family members. Jim’s community mental health nurse was contacted and visited Jim and his family in hospital and also provided the staff with advice about how to support him. Jim was admitted to the assessment ward for further tests but no further ward moves occurred. Staff in the ward had a good understanding and management of dementia and delirium. Mary and other family members stayed with Jim to support him and help out with his care. Staff work in partnership with Mary, other family members, and Jim’s community mental health nurse to support Jim to maintain his optimal abilities Jim was discharged home after three days

9. Scotland’s National Dementia Strategy 2010 5 key challenges 2 key service delivery areas Care in general hospital settings Improved post diagnostic information and support 8 actions to support change

10. Key actions to support change

11. Key actions to support change Quality of Life Outcomes Dementia Journey Levels of Expertise Informed Skilled Enhanced Expertise

12. Key service delivery areaCare in general hospital settings Educational resources Infrastructure, support, outcomes and evaluation Alzheimer Nurse Consultants and AHP consultants Dementia Champions

14. Thank you