Jan Killeen: The proper care in hospital is crucial for dementia patients

MORE than 71,000 people in Scotland have dementia and 60 per cent of them live in the community; either in their own home or with the person, or people, who are caring for them.

The majority of them will be in their 70s and 80s and are likely to have other health problems in addition to dementia: anything from joint pain and general physical frailty to diabetes and heart disease.

While we believe that access to better primary care can significantly reduce the need for people with dementia to go into hospitals, it is likely that many people with the illness will require in-patient hospital care at some stage. Often this is due to a fall-related injury.

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Going into hospital is a daunting experience for most of us, but particularly for people with dementia, who are likely to need much more support than other patients. The change of surroundings and routine can cause a great deal of distress to someone with dementia. Their behaviour can be disturbed by the unfamiliar and confusing surroundings. People with dementia can often have difficulty in telling others when they are hungry, thirsty, in pain or upset: staff who are not trained in dementia care may be unable to recognise, or appropriately respond to, these calls for help. Dehydration and malnutrition in particular can cause a huge deterioration in the condition of a person with dementia, as has been seen repeatedly in many high-profile cases over recent years.

NHS boards must commit to providing care that is suitable for people with dementia while they are in any of Scotland's hospitals and we recognise that the government and NHS are working together to make vital improvements. We hope that hospital care will be a key focus of the government's forthcoming National Dementia Strategy, which is due to be launched in the next few weeks.

Alzheimer Scotland sees appropriate hospital care as being a fundamental human right. Hospital staff should speak to carers and other family members about the needs and history of the patients with dementia, record this information and refer to it during the hospital stay. It is crucial that this information is updated regularly and passed on if the patient is moved to another ward or facility, to uphold continuity of care. Good nutrition has to be sustained at all times. Where physiotherapy is required, patients with dementia must always be assisted to perform their exercises. Before they are due to leave hospital care, discharge arrangements for support at home should be in place, so their needs can continue to be met.

One of the key ways in which Alzheimer Scotland seeks to improve hospital care is through our dementia nurse programme. We fund three dementia nurses every year, for up to 50,000 per annum, from our voluntary donations. We fund each nurse for a maximum of three years before the cost is transferred to the NHS board in which they are based. Though funded by us, our dementia nurses are managed and employed by the NHS: they work closely with mainstream multidisciplinary teams, and are normally based in general hospitals.

Alzheimer Scotland dementia nurses work with doctors and nurses to promote best practice and influence the way that people with dementia experience the NHS for the better. They offer information, advice and support and provide training to NHS staff on a formal and informal basis to improve standards in the hospitals in which they are based. One of our recently-appointed dementia nurses is based at the Royal Edinburgh Infirmary and is working closely with NHS Lothian staff to improve standards of awareness and care. Our dementia nurses have clear targets, including a significant reduction in the use of inappropriate anti-psychotic medication by NHS staff and a significant increase in the satisfaction with hospital care reported by people with dementia and their families.

There are many problems around hospital care for people with dementia in Scotland, but they are not insurmountable. With better awareness and understanding, as well as appropriate staff training and adequate resources, we can greatly improve the experience of hospital care for people with dementia and their families.

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