Beverley Marriott is Birmingham Community Healthcare Foundation Trust Nurse Practitioner – Community Matron based at Heart of England Good Hope Hospital. She is currently undertaking a Fellowship in Older People at Kings College London. Here she reminds us that we need to see the whole person when looking at someone with dementia.
Many of us work within dementia care on a daily basis. As a community matron on an AMU department supporting safe and timely discharges for patients with dementia, I understand the importance of getting it right and what happens when we get it wrong.
Dementia has reached a critical point – over recent years the government has seen improvements in diagnosis, raising public awareness and promoting dementia friendly settings. However to deliver this level of improvement requires, time, resources and focus.
The focus should not be on ‘dementia’ alone. 850,000 people in the UK have dementia, 42,000 are under 65 years. Unfortunately many of these people have other long term conditions that require time resources and focus. Studies have shown that 41 per cent have high blood pressure, 32 per cent have depression, 27 per cent have heart disease, 18 per cent have had a stroke or transient ischemic attack and13 per cent have diabetes.
In acute care settings treating patients can often be challenging if a person who has dementia presents with other medical issues. International Longevity Centre – UK (ILC) found that people with dementia are less likely to have cases of depression, diabetes or urinary tract infections diagnoseddue to their symptoms being ‘associated’ with their dementia diagnosis. People living with dementia and other comorbidities are also less likely to receive the equivalent level of care for similar conditions than people living without dementia due to delays in the recognition of new or exacerbating symptoms.
Frailty Nurse Consultant Marina Redford highlights how many of the patients she sees often have three or more long term conditions as well as a dementia diagnosis – highlighting the complexities in care patients need in order to meet their needs. It is estimated the combined cost for mismanagement of dementia and three long term conditions alone is at least £994.4 million annually (ILC – UK, 2016).
Elderly Care Matron, Donna Wooding highlights that dementia care needs to be individual, it’s not just a diagnosis, it’s a patient who may have multiple conditions and we need to ensure we focus on individual care not just a medical condition.
Various initiatives are being looked at to increase dementia patient experiences and to support environments – where history taking is more ‘relaxed’ and patient focused. For frail older patients it is extremely important that we get a collateral history to enable us to give person centred care. On admission to our wards relatives / carers are asked to complete an “All about me” booklet which helps us to provide more holistic care in a ward environment.
To support this one of the wards is “dementia friendly” with paints, clocks, dayrooms for activities. Volunteers support the wards by holding reminiscence activities, music therapy, pet therapy dogs and housekeepers run regular activities such as tea dances, themed afternoon teas and bingo.
Gareth Shaw, Senior Charge Nurse, Good Hope Hospital implemented a “calm care” concept in 4 bedded bays of patients with advanced dementia. This ensures that the bay remains calm for the patients and their relatives so conversations between health care professionals can be conducted easily. There is a nurse in the bay at all times, lights are dimmed with the door closed and only one activity takes place at a time rather than numerous activities occurring which often can lead to patients become upset or distressed. So far there has been a reduction in number of incidents in the bay.
There are some excellent examples of innovative approaches to caring for patients who have dementia. It is essential we provide quality care for patients diagnosed with dementia and adopt a whole systems approach – we can’t do it as individuals; we must work together. This is evident due to the complexity of presentations and carer support needed. Services should be developed around people’s needs not targets. The changing demographics of health and an ageing population mean the time for this to happen is NOW!!