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Supporting older patients with confusion and dementia
UHCW is committed to ensuring older patients with confusion and dementia receive an effective and compassionate service from the hospitals. Older people with dementia are admitted to the hospital for the same reasons as patients without dementia, but their stay may be more problematic due to not coping well with change of routines, noisy busy environments may be very confusing to them. They may feel frightened and bewildered, have difficulty expressing their needs, and their physical and mental health may also deteriorate further leading to increased length of stay.
Dementia is a term used to describe a group of symptoms that occur when the brain is affected by specific conditions. Dementia is a complex condition as in the early stages a person may appear to be coping well, but may be experiencing difficulty with communication or memory which other people may not realize, this is particularly so if the person is out of their normal routine or in a strange place. Symptoms of dementia include memory difficulty, disorientation and speech and understanding.
The National Dementia strategy (DOH 2009) highlights many of the problems that patients with dementia face in acute hospitals and gives a strategy on how to improve on this.
Staff at UHCW are committed to fulfilling the objectives outlined in the plan. The Trust has a lead senior doctor and two Clinical nurse specialists to support the recommendations of the strategy.
Over the last ten years the Trust has promoted a number of strategies to ensure that patients feel safe, their relatives are involved in the person’s stay and they do not develop complications because of their confusion which results in them having to stay in hospital for longer periods of time. Many of these strategies are outlined in the 2009 National Dementia strategy.
Forget-Me-Not Lounge and Memory Lane
As part of our commitment to improve the care we give to older patients with dementia and confusion, UHCW is implementing a care bundle which is a proven set of interventions to help older patients with dementia or confusion or who are frail have a better quality of stay during their time in hospital.
The Forget-Me-Not Care Bundle has specifically been designed to support older people with dementia. However, the Forget-Me-Not Care Bundle can be used for any patient who is frail, has dementia, appears confused or has difficulty with communication.
The Care Bundle has been implemented in other acute hospital settings and provided positive outcomes for patients with dementia, as it reduces fear and gives confidence to staff who work with patients with dementia.
The four key elements of this care bundle are:
- Involving the carer as soon as possible on admission, encouraging relatives to use the “getting to know me form”. Important personal information about how the person normally manages in their own environment, such as what does the person like to be known as; what helps them to feel calm; what helps them to eat and drink; how does the person express pain and discomfort? The use of a pain assessment tool, such as the Abbey Pain Assessment Tool may also help staff recognise pain for patients who cannot express pain verbally
- Personalised person-centred, compassionate communication
- Adequate assistance with eating and drinking
- Ensuring the environment for the patient is calming and is clearly signed
Other Interventions are in place to support patients with dementia in hospital these include:
- The Trust employs four clinical nurse specialists who have developed an understanding dementia course to all grades of staff since 2002; training has been increased to include induction of new staff and shorter awareness sessions.
Early identification of patient needs by encouraging medical and nursing staff to gather background history.
- Early identification and treatment of delirium promoting the use of the CAM (a tool for assessing a person with delirium) in all clinical settings
- The Trust works in partnership with the Hospital Liaison Team and has access to old age psychiatry, as UHCW is often the first port of call for patients with an undiagnosed dementia
There is a large drive within the Trust to ensure all patients especially those who cannot speak up for themselves to have enough to eat and drink. This is particularly true for patients with dementia.
Great attention is given to ensure patients are assessed on admission, that carers are contacted to find out how the person normally manages. Allowing carers to visit out of hours to help the patient with eating and drinking. Ensuring staff in clinical give areas give priority to spending enough time to ensure older frail patients have their food positioned correctly and they have the equipment needed.
People with dementia experience various difficulties eating and drinking. They can lose their appetite or may find it hard to communicate what they would like to eat or drink.
In 2012, Dietitians in Coventry and Warwickshire set up a Dementia Resource Group to provide information for carers and those with dementia. Please click on the following links for the two useful patient information leaflets about eating and drinking:
The training that the clinical nurse specialists provide, encourages staff to understand challenging behaviour as an expression of a need and to try to work out triggers as this behaviour often has multiple causes (e.g. physical mental, environmental, neurological) which is moderated by people’s emotions and beliefs, that is why we promote staff to use of the ABC CHART.
The employment of Activity organizers to prevent boredom and cognitive decline and the involvement of volunteers to “befriend” patients during the day, the volunteers also purchase the materials that go in to the activity packs.
The Trust are committed to ensuring our workforce has the skills and knowledge to cater for the needs of people with dementia. The Trust works in partnership with North Warwickshire and Hinckley College to provide a free national accredited NCFC certificate in the principles of Dementia care. For further information please contact Suzanne Roberts in the training department 02476 968708.
The Dementia and Frail Older People’s Team are currently trialling a carers support group for relatives of people with dementia or confusion. The group provides support to people by answering any queries they have about their relative’s care while they are in hospital, but also giving advice about services available after they are discharged. They will also be able to meet people in the same situation, and to get answers to any other queries they may have about dementia and confusion.
The Dementia Carers’ Support Group takes place every Tuesday at 2-3pm in the Dementia Lounge at University Hospital from July 2015 onwards. The meeting is facilitated by the Clinical Nurse Specialists for dementia. Initially, the group will be especially for relatives of patients on Wards 20, 21 (Medicine) and 40, as these wards typically have the highest percentage of patients with dementia.
If you are interested in attending the group, please contact the Older People’s Team on 024 7696 8333.
Nurses who support frail older people and patients with dementia at University Hospital, Coventry, Rose O’Malley, Liz Kiernan and Tracey Chapman (pictured right) work 9-5 Monday- Friday. They can be contacted by dialling 024 7696 8333. They are happy to answer questions on any of the interventions already mentioned and give advice and support to clinical staff on any aspect of care relating to older people with dementia which includes:
- Mobility Discharge planning
- Dealing with difficult behaviour
- Mental capacity advice
- The use of deprivation of liberty safeguards
Specialist Mental Health Nurse, Debbie Harris (pictured right) supports all patients 65 and over at the Hospital of St Cross, Rugby who may have dementia or a mental health illness. She is available to offer advice, support and assessment to patients, carers and staff.
Debbie works Monday- Friday (except Wednesdays) between 9am-5pm. She can be contacted by dialling 01788 663044.