Delirious about dementia, that’s what we would like all geriatricians to be, but sadly they are not!

A consensus document put together by a working group comprising members of the Cerebral Ageing and Mental Health SIG, has been circulated to all members and is available from the BGS website (pdf format). I would commend you to read it and disseminate it amongst your trainees and multidisciplinary teams. It is our hope that the document will act as a catalyst to engage more geriatricians in the diagnosis and management of cognitive impairment, in collaboration with their colleagues in old age psychiatry.

The detection and management of cognitive impairment should be central to the practice of geriatric medicine. Dementia has a high prevalence in our patient population and is a significant risk factor for falls, incontinence, delirium and poor adherence to medication regimes. Dementia is also a frequent complication of Parkinson’s disease and stroke; and is associated with ‘frequent flier’ status, increased length of hospital stay, carer strain and increased risk of institutionalisation.

The recent (2005) Royal College of Psychiatrists’ publication ‘Who Cares Wins’ has emphasised that of the two thirds of DGH beds occupied by older people, two thirds of these patients will have mental health problems (mostly dementia and delirium). In all aspects of our clinical work, geriatricians can not avoid meeting patients with cognitive impairment and therefore must not shirk responsibility for the detection and recognition of dementia (delirium too). Improved detection must then lead to coordinated care. The consensus document recommends a case-management approach co-ordinated by the local department of old age psychiatry. To what extent geriatricians manage the longer-term needs of dementia sufferers and their carers will vary between centres. However, the group firmly believe that every department of geriatric medicine should have a lead clinician for cognitive impairment, as many already have leads for stroke and falls services and so on.

The consensus document suggests a simple screening algorithm for detecting delirium and dementia that could be easily incorporated in to the clerking proformas of all DGHs. It is our aim to put the assessment of cognition on a par with the assessment of cardiac chest pain, falls, heart failure, etc. The group have chosen screening tools that will be familiar to most geriatricians and, if not, are simple to learn and use. It is our intention to produce these as a tool kit, early in 2006 that can then be made freely available to all BGS members.

The group are delighted that the BGS has endorsed the consensus document and chosen to make it available on the BGS web site. www.bgs.org.uk (Select Publications and reference material). We hope shortly to have similar endorsement from the Faculty of Old Age Psychiatry. We believe it is essential that geriatricans ‘own’ dementia and work closely with our old age psychiatry colleagues, locally and nationally, to ensure that our mutual patients receive best possible care. Those of you fired by our enthusiasm would of course be welcome at any of the SIG meetings.

Duncan Forsyth
Chair of Consensus Group
Immediate Past Chair Cerebral Ageing and Mental Health SIG