Supporting people with dementiain the hospital setting and reducing the negative impact on patients

Rebecca LambertHead of Therapy, Mental Health of Older Adults South London and Maudsley NHS Foundation Trust

Session objectives• Change your perceptions of the “challenging behaviour”

experienced by patients with dementia

• Challenge existing system structures to be person not organization focused

• Use the IHI “flipping” concept to understand competing interests between patients and healthcare organisations

• Identify useable resources to support patients with dementia during their hospital admission and prevent deterioration

About me

Miriam Fitter My grandmother

Janny

David Fitter My grandfather

Jannydad

Dementia in the UK

One in six people aged 80

850,000 in 20151 million by 2025

670,000 carers

Costs the UK £26 billion every year

25,000BME

Two thirds are women

Directly attributes to 60,000 deaths

every year

40,000 people under

65

2/3 live in community

The Department of Health “State of the Nation” report:“An estimated 25% of hospital beds are occupied by people with dementia”

Dementia in hospital

• Only 2 per cent said that, in their experience, all hospital staff understood the specific needs of people with dementia

• 57 per cent said they felt the person they care for was not treated with understanding and dignity in hospital

• 90 per cent said they felt the person with dementia became more confused while in hospital

• 92 per cent thought hospital environments were frightening for the person with dementia

• £264.2 million was wasted due to poor dementia care in hospitals in 2013/14

Alzheimer's Society research into hospital care

People come to hospital to get

better

They cant find the toilet so they

become incontinent

We worry that they will fall so

we don’t let them walk

We give them no stimulation so they become withdrawn

and depressed

They get angry or frustrated so we have them followed/

sedated

And then we say they have deteriorated “because of their dementia”

Compassion fatigue

Staff who are scared to do things differently

Expectations from families and carers

Reactionary not preventative care

Lack of flexibility within the system

Flipping

Centering the care on an individual's needs

“what matters to you?”

Focusing only on illness

“What’s the matter?”

15

The influence of language in hospital

Words to avoid Alternative words • Dementia sufferer • Demented • Senile or senile

dementia • Burden• Victim • Plague • Epidemic • Enemy of humanity

• Afflicted• Wanderer• Sundowner• Empty shell• Losing his/her mind• Loss of self• Not all there• Behaviour problem• Living death

Person with dementia Person living with dementia Person living well with dementia

The language we use to talk about dementia influences how people with dementia are viewed and also how they feel about themselves.

(Dementia Engagement and Empowerment Project)

Language

Distress behaviour

What types of distress behaviour” do we see in hospital's?

“Our behaviour is often referred to as ‘challenging’, but is usually the only means left for us to express our anxiety and emotion, and the distress we are experiencing due to our care environment”

Christine Bryden

19

20

Behaviour = communication

The

iceberg

Diagnostic overshadowing

Flipping

Staff Perspective

Patient perspective

• Bed 12 – Helen Jones (83) admitted overnight

• Brought in from the care home due to increased confusion

• Likely cause – UTI

• For antibiotics and IV hydration

• Will need 1:1 special as wandering around the ward asking for her handbag

• Risk of aggression

• Close monitoring of diet, fluids and medication as non-compliant

• Aim discharge back to care home in 3 days

Scenario

Helen’s perspective

Scenario

• Helen Jones was transferred to our care overnight

• The carers supporting Helen feel she is increasingly distressed but are unsure why.

• Initial diagnostics indicate a UTI

• Following clarification of diagnosis the plan is to initiate medical treatment

• Helen will benefit from 1:1 care to support and reduce her distress

• 1:1 carer staff will develop trust with Helen to promote eating and drinking and medication

• Aim to transfer her care back to their care

Scenario

• By challenging the perceptions of behaviour in patients with dementia, you can start to challenge the set up of the system.

• Not only focussing on patient facing staff but infiltrating executive teams and keeping it on the agenda

If you get it right for people with dementia, you get it right for everyone

What about the system?

• People with dementia

• DAA hospital charter

• RCN – SPACE principles

• Health Education England

• 15 Steps challenge

• Alzheimer’s Society

• NICE guidelines

• Strategic Clinical Network

Useable resources

The biggest resource you have is the experience of

your patients and compassion of your staff

Thank youText BEXL83 £5 to 70070

to sponsor my marathon in aid of Alzheimer’s Research UK

• Commitment to the care of people with dementia in general hospitals. RCN• Improving quality of care for people with dementia in general hospitals• Alzheimer’s Society (2009) Counting the Cost: Caring for People with Dementia on Hospital Wards. AS, London.• Alzheimer’s Society (2010) This is Me. AS, London. http://alzheimers.org.uk/site/scripts/documents_info.php?

categoryID=200149&documentID=1290&page Number=1 (Last accessed: May 31 2010.)• Cunningham C, Archibald C (2006) Supporting people with dementia in acute hospital settings. Nursing Standard.

20, 43, 51-55.• Bridges J, Flatley M, Meyer J et al (2009) Best Practice for Older People in Acute Care Settings (BPOP): Guidance

for Nurses (2009). Nursing Standard. 24, 10, CD-Rom.

• Department of Health (2009) Living Well with Dementia: A National Dementia Strategy. The Stationery Office, London

• Archibald C (2002) People with Dementia in Acute Hospital Settings. Dementia Services Development Centre, Stirling

• My name is not dementia https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1339

References

• 15 steps challenge http://www.institute.nhs.uk/productives/15stepschallenge/15stepschallenge.html#sthash.jOoP9Aaq.dpuf

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