Cognitive impairment, mortality and discharge from an acute hospital

Carole Fogg is a Senior Lecturer at the University of Portsmouth/Portsmouth Hospitals Trust, (UK). She is a PhD Fellow under the Wessex Collaboration for Leadership in Applied Healthcare and Research, exploring hospital care and outcomes for patients with cognitive impairment and dementia. Her paper “The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study has recently been published in Age and Ageing. She tweets at @Carole_Fogg 

When older people with dementia are admitted to hospital, they are more likely to die or to stay in hospital longer than people without dementia. Many older people have cognitive impairment (CI) (problems with memory and thinking) which is a main feature of dementia, but have not yet been given a diagnosis, or may have CI due to other medical conditions. We investigated how common cognitive impairment is in older patients in hospital, and what the risks are for these patients of staying longer or dying in hospital. Continue reading

Take time to talk! The importance of an informant history

Adam Dyer is a Final Year Medical Student in Trinity College Dublin. Dr. Sean Kennelly (MB PhD FRCPI) is a Consultant Physician in Geriatric and Stroke Medicine in Tallaght Hospital (Dublin, Ireland) and a Clinical Senior Lecturer in Medical Gerontology at Trinity College Dublin (TCD). The following work was presented as a platform presentation at the 64th Irish Gerontological Society Meeting in Killarney, Ireland (October, 2016).

Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?

An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading

How to be a Delirium Superhero this World Delirium Day

Hazel Miller, Consultant Geriatrician, Glasgow Royal Infirmary.  Delirium enthusiast (or should that be delirium hater?) hoping she has earned the right to don a cape from time to time…  Follow me on twitter @hazelmiller99

It’s fair to say that our understanding and management of delirium has increased hugely over the past ten years.  It has gone from being the ultimate in Cinderella syndromes (unanticipated, undiagnosed, untreated, unexplained, unnoticed) to having high profile and energetic researchers and advocates (its own Delirium Superheroes).  Everyone is being asked to Think Delirium these days. Continue reading

Accurate delirium screening when there is no carer available – impossible, right?

Suzanne Timmons is a geriatrician working in Mercy University hospital, Cork and a senior lecturer in University College Cork. She has a big clinical and research interest in delirium and dementia care in hospitals.

delirium-flatDelirium  is common in older people admitted to hospital, and is a serious condition that needs to be identified quickly on admission. But many busy hospital staff still don’t routinely screen older people for delirium, even when they have known dementia (dementia puts people at very high risk of delirium: see the Cork Dementia Study).

In this study, we tested out five simple cognitive tests to see if they could be used to screen for delirium. The tests were: the Six-item Cognitive Impairment Test (6-CIT; measuring attention, orientation to time, and short-term memory); the Clock-Drawing test; Spatial Span Forwards (pointing to a sequence of squares in a certain order); reciting the months of the year backwards (MOTYB); and copying a shape containing two intersecting pentagons. Continue reading

Cause of death? Dementia…

Professor Emma Reynish is a consultant physician in Geriatric Medicine at Edinburgh Royal Infirmary, and Professor of Dementia Research, at the University of Stirling where she leads the dementia and social gerontology research group.

dementiaIn England and Wales more people now die of dementia and/or Alzheimer’s disease than anything else. A similar picture is most likely to exist for the other devolved nations of the UK. For healthcare professionals who are involved in the management of people with dementia, this news offers the opportunity for reflection and action. What does this mean for us and our approach to the older population? Continue reading

The chasm of dementia; a carer’s perspective

Sue Newsome supported her Father during the last year of his life after he was diagnosed with Vascular Dementia. In this blog she shares her thoughts and feelings from a carer’s perspective.  

bench-forest-trees-pathSupporting someone with Dementia is a contradiction of what it is ok to feel and the guilt about those feelings. A whole raft of thoughts, feelings and behaviours that I continually checked and reviewed. My relationship with Dad changed, he had never said he was scared before and I was to hear this from him throughout his Dementia journey.

Initially in his phone call to me telling me ‘Sue I am scared I am having a Stroke’ which although slurred was articulate, to the same feeling the night before he died when despite his end stage Dementia and aspiration pneumonia, when he struggled to breathe, he managed to say ‘I’m scared’. His fear and mine punctuated our relationship for the last year of his life. Our fear of the future what it held and how we could adapt. It felt like I held my breath for a year. Living on adrenaline, the skipped heartbeat when the phone rang, what had happened to Dad this time! Continue reading

John’s Campaign Conference; Stay with me

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She was one of the speakers at the John’s Campaign Conference. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

johns-campaignI was proud to be invited to speak this week at the John’s Campaign Conference on 12th October. The conference proved to be an oasis of light, love, and hope in the often gruelling and lonely journey of dementia. Nicci Gerrard and Julia Jones, co-founders of John’s Campaign, who both have personal experience of caring for loved ones with dementia, pulled together a groundbreaking and heartwarming conference, which was nothing short of miraculous. Nicci and Julia began what they described as a ‘kitchen table revolution’ to campaign to change the draconian restricted visiting arrangements of adult hospital care, advocating that people with dementia should have the support of their loved ones while in hospital. Continue reading

Which screening tool(s) should clinicians use for the detection of delirium in older, hospitalised patients?

Kirsty Hendry is a research assistant based at Glasgow Royal Infirmary having recently completed her PhD at the University of Glasgow. In this blog she discusses her recent Age and Ageing paper looking at screening of delirium in older, acute care in-patients. Kirsty can be contacted at Kirsty.Hendry0@gmail.com

A&ADelirium, suggested to be the most common psychiatric disorder suffered by older hospitalised individuals, has a low clinical awareness. This is despite existing guidelines such as those produced by the National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) being in general agreement that delirium screening is important in older hospitalised patients.  Continue reading