Wednesday, July 1, 2015

Dementia Care in Hospitals Program

It’s 10am on the morning of 25 June, and I am in the auditorium of The Canberra Hospital (TCH) listening to Associate Professor MarkYates of the Ballarat Health Services Dementia Care in Hospitals Program explain what this program is about to the assembled TCH staff. He’s clearly practised at it, which might be expected, since the program has been embedded in no less than 25 Victorian health care providers to date. It’s been so successful at improving the experience of treatment in hospital for patients with cognitive impairment that it’s pretty much standard in Victoria.  Mark is here today to kick off the program’s national rollout. TCH is one of four pilot sites across Australia selected to introduce the program and 18 months later, comprehensively evaluate its effect.

Prior to Mark Yates, we hear from Jane Allen, the CEO of Alzheimer’sAustralia ACT. She tells us that ‘dementia’ is a catch-all term for a range of symptoms and types of cognitive impairment, of which the most common is Alzheimer’s, but it is only one of over one hundred possible diagnoses. It’s most common in the over-65 age group, but its prevalence is increasing amongst younger people, although no one is sure why. It’s the single greatest cause of disability for older Australians. While people don’t often present to hospital with dementia as their primary issue, people with dementia are prone to a range of injuries and illnesses, and therefore more likely than those without dementia to be in hospital. For these people, the busy hospital environment is a confusing and stressful place, and can cause challenging behaviours as they try to cope.

Dr Anil Paramadhathil is the Director of Geriatric Medicine at TCH, and the man leading the introduction of the Dementia Care program here. He shows us data from some research he did recently, which looked at the proportion of the total people admitted to TCH over 6 months who had some form of cognitive impairment noted on their record. He had expected 20-30%, a proportion which would be in line with what the Ballarat team’s research has found. He found less than 1% had this information on their record. This backs Mark Yate’s assertion, that 1 in 5 families feel that the hospital has no idea that they are caring for someone with cognitive impairment.

This morning session is about what the program does and how it helps. It’s a simple program with three main elements. The first, and to my mind most radical, is that all adult patients admitted to hospital are screened for cognitive impairment. It’s not as onerous as it sounds, because it’s not a diagnosis, but one or more simple tests of function. For example, request the patient to draw a clock face, and then draw on the hands of the clock to show ten past eleven. I learn that the ability to carry out this apparently simple task says a lot about the absence or presence of cognitive impairment.

Step two, once cognitive impairment is found, is placing a symbol at the patient’s bedside to alert staff, in much the same way as a hearing or sight impairment would be identified. The beauty of a simple, visible symbol is that any of the staff approaching the bedside, from the food service staff to the clinical team, will receive the same message, and providing they have been effectively trained in caring for people with cognitive impairment, a systemic dementia-appropriate response should occur. Mark shows us the symbol, which was developed with a consumer focus group. To me it looks like someone radiating superpowers, but apparently explaining what the abstract symbol means has become an opportunity for staff education, and that’s got to be a good thing. Mark assures us that when this program is in full swing, we’ll see that symbol above one in three of all adult beds in TCH. 

The last part of this program is staff training in how to care for and communicate with patients with a cognitive impairment and their carers, so that staff know how to modify their own behaviour and responses in these circumstances.

The afternoon session of staff training begins with the story of Joan, whose husband Kyle was hospitalised  at an unnamed hospital for a minor operation. Kyle suffered from Alzheimer’s, and when he was hospitalised Joan asked that this information was clearly marked on his notes. The information seemed to have gone missing fairly soon after admission however, and things went downhill from there. Kyle’s Alzheimer’s wasn’t necessarily obvious to a casual observer, and when Joan witnessed, among other things, a nurse presenting Kyle with his medication, asking him to take it and then leaving him to it, she realised that although she hadn’t planned to stay, she would have to, as there was no way he could follow such instructions by himself.  Things came to a head when a family member noticed that Kyle had removed his patient ID band because it was bothering him. Joan advised the hospital that he needed another one but before this was done, and in one of Joan’s absences, he disappeared. I’m sure I wasn’t imagining the discomfited seat shifting in the nursing staff around me as we listened to this tale. Fortunately the situation resolved without further drama, as Kyle turned up on foot at his son’s house 3km away, but not before the police were involved and a procedural hole a mile wide was clear for all to see.


I have a different perspective when I leave the auditorium. As I emerge into the foyer I am momentarily disorientated and it takes a few seconds to see which way I need to go. I notice it is noisy, and those bright artificial lights are a bit stressful. All around me are strangers dashing, limping, wheeling hither and yon. I’m OK though; I know where I am and I’m pretty sure I can still draw a clock face and place the time on it. It’d be good if I could also remember where I parked the car though.

Kate Gorman
Consumer Representatives Program

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