Living and Dying with Dementia
(a Hospital Perspective)
Dr Oliver J Corrado,
Consultant Geriatrician, Leeds Teaching
Hospitals and LTHT ‘Dementia Champion’
Setting the Scene
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Dementia affects 800,000 people in England and Wales
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Not just older people, 17,000 in UK are aged under 65 years
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8400 people in Leeds with dementia, will rise to 12000 by 2026
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25% of adult general hospital beds used by people with
dementia
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Common cause of admission to hospital particularly due to
falls (and fractures) and infections (which make people more
confused)
Setting the Scene
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Although dementia is very common it is under recognised
(even by health professionals) and under diagnosed
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only 45% (data from 2013) of people with dementia in UK have a
formal diagnosis
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Prime Minister has set a challenge to increase the number of
people diagnosed with dementia to 66% by 2015
Dementia Diagnosis Rates for Yorkshire & Humber
Data source: State of the Nation report Dec 2013. Based on QOF data 2012/13.
Proportion of those on dementia diagnosis registers
in Leeds
90% of people with dementia in Leeds have another long
term condition eg heart disease, chest disease etc
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
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4
5
6
Number of long-term conditions (including dementia)
7
What Is Dementia?
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It is not a normal part of ageing process
It is a condition which affects the brain and causes
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Memory loss (particularly for recent events)
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Difficulty thinking things through and planning
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Being confused in time or place
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Can affect mood and behaviour
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Communication difficulties
It progresses with time
Commonest causes are Alzheimer’s disease (50%) and
vascular dementia due to poor blood flow to brain (20%)
Improving Dementia Care in Hospital
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Help identify/diagnose people with dementia
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Better and safer prescribing
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Person-centred care
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Better information, advice and support for patients and carers
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Reducing risk and aids and adaptations
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Dementia friendly hospital environments
Help identify/diagnose people with dementia
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< 50% have a diagnosis currently
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Frequently admitted to hospital
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Department of Health introduced a hospital screen (called a
CQUIN) in 2012 for all people aged over 75 admitted to hospital.
Patients who are ‘confused’ in hospital or admit to being
increasingly forgetful are given a quick memory test and if they
score low referred for further review and assessment.
Helping to increase diagnostic rates
Better and safer prescribing
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People often come to hospital
on lots of medication
Risk of not taking them or
taking too many
The side effects of medication
can make people drowsy or
more forgetful
Hospital admission is a good
opportunity to review
medication, assess need and
use devices to improve
compliance
Person-centred care
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Valuing the person with dementia, treating them with dignity
and respect. Finding out more about them as individuals, their
interests, likes and dislikes
“Know Who I Am” / “This Is Me” to find out more about person
“Forget Me Not” symbol to raise awareness
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Providing assistance with eating, toileting and other aspects of
personal care when needed. Also recreational activities.
Finger food and snacks, cake at tea time, picture menus,
“dementia friendly crockery and cutlery”. Volunteers to provide
assistance with eating and for recreational activities
Better information, support and advice for carers
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7 million carers in the UK (1 in 10 people)
60% of people will be a carer at some time in their
life
65% of carers aged 60-94 have health problems of
their own
Ill health, depression and financial problems are
common
Do hospitals do enough to support them ?
Leeds Carers’ Survey
Leeds Carers’ Survey
Leeds Carers’ Survey
Carers’ Support
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With Carers Leeds appointed a Hospital Support
Worker for carers of people with dementia
Better signposting to support agencies
Better information and advice eg on benefits such as
attendance allowance
Lots of support available in Leeds
(www.leedsdirectory.org)
Advice to People with Dementia
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Get financial affairs in order (if mental capacity to do
so)
Make Will
Lasting Power of Attorney
Benefits
Advanced decisions/directives
Keep active, books, newspapers, life story, cognitive
stimulation, scrap books, photos music playlists
Reducing Risk and Adaptations
Occupational Therapist
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Reduce risk, fires, cookers
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Smoke detectors and alarms
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Body-worn alarms
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Assistive technology eg for wandering
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Timers
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Downstairs living
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Remove clutter
Physiotherapist
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Mobility assessments and walking aids
Dementia Friendly Hospital Environments
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Signage
Lighting
Paint
Colour
Photos
Pictures
Calendars
Big face clocks
Matt even flooring
Lighting
Domestic seating
Avoid clutter
Bradford Hospitals DF Wards
Dementia and Dying
A ‘good death’
Ensure people die in comfort and with dignity
Forward planning is important, (wherever possible) respect
wishes about place of death, funeral arrangements, readings
(or not), choice of music etc. We are very bad at talking about
death.
Involve families and friends in process
Ensure spiritual needs are met
Dementia and Dying
Avoid unnecessary hospital admission when the best place for the person to
have end of life care is home/ their care home. Improve communication with
families and between health professionals in hospital and in primary care
(GP) about treatment decisions and end of life care.
Recognise when someone is dying and when further active treatment is
not in their best interests.
Good palliative care support and hospice care if needed (these are
not just for people with cancer !)
Bereavement support
Dementia and Dying
You only live once ….. but you also only die
once ! (Dying Matters)