Daniel Sommer is a Core Medical Trainee in South East Thames. He is an aspiring Geriatrician. He tweets at @danielf90
I am committed to a career in geriatrics partly because I want to help people with dementia live safe, happy and productive lives. Working on an acute geriatrics ward is an amazing privilege. I’m constantly overwhelmed by the humanity of the staff that I work with. They seem to have endless patience and a genuine enthusiasm for what they do. In the face of huge challenges, staff shortages and under funding, our staff members provide an astonishing level of care for all patients, especially those with dementia. We have dementia boards, dementia boxes, dementia specialist nurses, dementia pins, dementia stickers and dementia clocks.
It feels silly telling an interested and educated audience [yes, that’s you!] about cognitive impairment, but I feel it’s important to be mindful of the scale of dementia and delirium in society and in the acute hospital. According to the Alzheimer’s Society, 7% of over 65s have dementia. A recent BMJ paper indicated that 34.8% of acute hospital in-patients over the age of 80 suffer from delirium, and 50.9% of those had an underlying dementia. This is not something than any healthcare professional can ignore.
With the above in mind, you’ll have to excuse me if I get more than a little bit irritated and hurt that some patients and their relatives are offended by the word “dementia” or that they demand to be moved off the “ward full of lunatics” because it’s “bad for their health”. That may sound extreme, but I hear these words as well as milder, more sanitized iterations more than I would like to. What upsets me even more is when I see managers and other members of staff bending over backwards to apologise for these patients.
We have nothing to apologise for. We are servants to the public and work for the National Health Service. We should be proud to treat everybody who needs to be treated, without discriminating based on income, race, sexuality or mental capacity. Yes, some patients with dementia have very challenging behaviour, but we should never have to apologise to other patients/relatives for their mere existence on our ward.
Our patients are the most vulnerable people in the hospital and they cannot advocate for themselves. Instead of apologising, we need to be politely explaining what dementia is and what dementia isn’t. Dementia is NOT an infectious disease and having a person with dementia in the bed next to yours will NOT slow down your recovery, nor will you have worse healthcare outcomes.
We need to be firm and do justice for the people who cannot speak for themselves, even if this means this means telling patients and their relatives that the words they use are unacceptable. Only by doing this will we reduce the stigma of mental health. Capitulating to unreasonable demands as moving patients away from the “dementia ward” or taking down a “dementia information board” is not the way forward.
Our message needs to be consistent – dementia is not a scary word and our patients with dementia should not be treated as second-class patients. Nobody else is going to stand up for your patients, so make sure that you do.