Helen Martin: Dementia timebomb has already exploded

Published on Monday 23 November 2009 08:39

THERE is nothing new in the claims that elderly patients with dementia are not properly cared for in hospital . . . if by "properly" we mean by staff who understand their needs. It's an age-old problem, in more ways than one.

The current spate of headlines owes more to the fact that we've now hit crisis point. As people live longer, more and more are suffering from the condition. Around a quarter of all hospital patients have some form of dementia, a proportion that is absolutely certain to rise.

Almost 90 per cent of nurses believe dementia patients are treated with dignity and respect. But since eight out of ten admit to having had no specialist dementia training, they are speaking from a position of substantial ignorance. Any carer can tell you that.

Angela Rippon is currently campaigning on behalf of the Alzheimer's Society for more training for doctors and nurses. As she admits, the care hospitals gave her late mother for other medical conditions was superb. But with no understanding of her dementia, anything they did was going to be flawed.

A psycho-geriatric ward will have more expertise. But a general orthopaedic ward may not be set up for such special needs. Their business is bones, not dementia. Nor is the hospital machine capable of listening to and placing sufficient importance on the advice of relatives and carers.

The most common complaint is that meals are put on a tray before the patient and removed an hour later, untouched. It isn't just that people with dementia forget to eat. Many seem to have lost the ability to assess their own hunger or even to make the connection between the food in front of them and getting it into their mouth.

They may not be incontinent but they may very well be unable to find the toilet. They may be shivering with cold as many elderly do, but totally incapable of putting on the cardigan they are holding.

Why am I such a smarty pants? Because like many carers or family members, I've experienced it. At ten years old I found my great aunt bewildered and barricaded in her flat. For various reasons I had to stay with her, feed her, help her drink fluids and try to calm her for almost 24 hours before anyone could come and help. My late mother-in-law had dementia. Now my mother has it too.

And I am constantly amazed by the ignorance I've encountered in hospitals where, one would expect, medical people would know better.

My mother-in-law fell and broke her hip. She had it pinned in the ERI and when we went to visit her she was sitting up in her chair, blue with cold and shivering. She had been brought in straight from her care home with the minimum of clothing so I asked the ward if they had an extra blanket or another dressing gown until we could bring in her own warm clothes. Totally unembarrassed that we had found her in that state, they said they didn't have any extra blankets. In the ERI? I settled for a couple of hospital towels.

As was the case with an elderly lady featured last week in the Evening News, she received no physiotherapy. The reason given was that so much of physio at the time was exercise-based. She couldn't remember the exercises so there would be "no benefit".

Somehow an assumption has grown in hospitals and among professional carers that the elderly with dementia have small appetites and require only tiny meals. Funnily enough, malnutrition and weight-loss are big problems. All my demented relatives have had one meal-time characteristic in common. Give them a couple of digestives, or a sandwich, tell them it's lunch, and they're satisfied. But lay on soup, mince and potatoes and pudding, sit with them, preferably eat with them, and they'll scoff the lot.

My mother was attending a hospital day centre. Staff had arranged an audiology appointment for her with a specialist in another unit. She was given a return appointment but no-one else was told, not the day centre, not me. How on earth was that going to work? Luckily I found out about it and put the question to them. The reply? "It is the patient's responsibility to attend appointments." I explained she had dementia. "Sorry, this is the audiology department." Well, thanks for your help.

Hospital hierarchies and directors will come out with all sorts of platitudes and reassurances about the care of patients with dementia. It's poppycock. They are hopeless at it, as the Alzheimer's Society is pointing out.

Proper care of dementia patients is labour-intensive and expensive. It requires knowledge yes, but above all good, old-fashioned care, understanding, common sense and patience, which don't always fit in with streamlined hospital systems and procedures, efficiency measures and time restraints.

And no . . . we are not waiting for a time bomb to explode. It's going off all around us now, as we speak.