Dave Jolley is an Honorary Reader in Old Age Psychiatry at the University of Manchester. Claire Hilton is a Consultant Old Age Psychiatrist at Central and North West London NHS Foundation Trust’s Older People and Healthy Ageing Service. Their editorial Fit for purpose? Dementia and the healthcare professions was recently published in Age and Ageing journal.
Deborah Mayne and her colleagues find that even geriatricians who are prepared to be identified as Dementia Champions fear they do not know enough about dementia and had to struggle to obtain sufficient and appropriate education in their training years.
Most of the morbidity of the population is compressed into late life and multiple pathologies commonly occur across the physical-mental spectrum. Among older people, dementia is found nearly everywhere; depression, anxiety and delirium are common; and sometimes other mental disorders are found. Dr Mayne and her colleagues have made a hugely important point: educate our health professionals to be comfortable and competent with the population who become ill: their needs are not uni-dimensional.
Patients, families, family doctors, social workers and other colleagues face a morass of ever changing, disappearing and reformulating teams, in response to local commissioning priorities. Health and social care provision by ‘any qualified provider’ encourages competition rather than collaboration: the joined up ideal ‘seamless service’ has been trampled in the stampede toward paper-trail excellence and watertight finances. Should services not make themselves fit to provide for people’s needs, rather than leave people to wonder how their needs might match predetermined inclusion/exclusion criteria?
Whichever team they are in, professionals working with older people require education and training to help the whole person: physical, mental, social and spiritual. Yet nursing students are required to choose early between courses labelled ‘adult’ or ‘mental’. This is a false dichotomy in biological terms and produces two streams of people ill-equipped for the tasks which real life presents to them. Matters are not quite so extreme within medicine, though most clinical courses are still heavily loaded toward physical health. At present primary care is best equipped. The specialisms of geriatric medicine and old age psychiatry ought to work, learn and research together.
So how might we make amends?
We all have strengths and weaknesses, in our personalities, our styles of working and in our clinical work. It is important to know our limitations, and to know who to ask for advice. It is not only a question of what you know; what you can do with it is more important.
There is much we can learn from each other, not just within professions, but from patients and families and across multi-disciplinary teams, and spanning traditional boundaries between agencies. Becoming better informed by such a process increases our skills and nurtures strengths and respect between colleagues and between professionals and the people receiving care and treatment. Both postgraduate and undergraduate education can be remodelled to make strengths from what now appear, by division, to be weaknesses.
By sharing our knowledge and skills – within and beyond our traditional clinical teams – we can better understand our patients’ clinical presentations and discover ways of helping them.
This is what seamless service provision really means: it can be done.