National dementia audit in acute hospitals shows major gaps in care

MICHELLE McDONAGH

The first national audit of the quality of dementia care in Ireland’s acute hospitals has identified major gaps in the level of patient care.

The audit of 35 acute hospitals, carried out in 2013, revealed serious shortfalls in the training of staff in dementia care.

None of the hospitals had mandatory dementia awareness education or training for staff.

Inadequate assessment
It also highlighted inadequate assessment of cognition, delirium, mood, and behavioural and psychological symptoms, in people with dementia during their admission and on discharge from hospital.

The Irish National Audit of Dementia was carried out by the Centre for Gerontology and Rehabilitation, University
College Cork; the Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences; Tallaght Hospital Dublin; and the HSE Quality and Patient Safety Directorate.

Dr Suzanne Timmons, senior lecturer at UCC, who co-led the audit, said the results were in line with the findings of the first UK audit in 2010.

The second UK audit in 2012 showed improvements in many areas from the first round of audit, and it was expected that the same would be true for Irish hospitals, she said.

"A key finding was that the dementia care training provided in all of the acute hospitals to doctors, nurses and allied healthcare professionals was not sufficient," said Dr Timmons.

No delirium screening
"We also found that no hospital was screening for delirium which is very common in patients with dementia who are being admitted to hospital.

“Delirium is an acute confusion [whereas dementia is a chronic confusion] with very poor outcomes.

“Somebody with delirium in hospital is twice as likely to die and four times more likely to need long-term care.”

Consultant geriatrician Prof Des O’Neill, who co-led the audit, commented that it highlighted major deficits in the provision of dementia care but major opportunities as well.

“Even though dementia is such a significant illness [affecting up to 25 per cent of patients in a typical general hospital at any one time], the system is unprepared for it.

“There is a need for routine training in dementia care for everybody dealing with adults with dementia and a need for much better protocols to detect delirium and assess cognition on admission,” said Prof O’Neill.

Prof O'Neill noted that the publication of the audit was timely as the results had been fed into the National Dementia Strategy which was due for release soon.

Must up their game
Prof O'Neill pointed out that the HSE had come on board as partners in this audit and the onus was now back to the nursing and medical professions to up their game in terms of their under and postgraduate training.

The audit identified 45 recommendations for the care of people with dementia in acute hospitals, which include the development of training strategies in each hospital, the development of policies for the identification and treatment of delirium and assessment of the mental status of people with dementia on admission.