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| The National Dementia Strategy Will it improve dementia care? |
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| Email your comments The National Dementia Strategy - will it improve dementia care? Yes, if geriatricians and neurologists, and not just old age psychiatrists (OAPs) engage with it! It was unfortunate that the sound bite from the launch of the National Dementia Strategy (NDS) was, ‘a memory clinic in every city’, for to many clinicians a clinic means bricks and mortar, walls and a roof. So, not too surprising that the next sound bite that I heard was, ‘memory clinics are unproven in their effect on dementia care’. Ah, so sad that those (hospital-based) making these comments neither appear to have read the NDS in its entirety nor to have understood the concept of virtual clinics. The NDS is about team work and patient centred care, not bricks and mortar, OAPs understand this for they are used to working outside the institute (I believe it’s called the community or ‘real world’) and taking the service to the patient.
The aim of the NDS is to ensure that significant improvements are made to dementia services across three key areas: improved awareness; earlier diagnosis and intervention; and a higher quality of care. The NDS identifies 17 key objectives which should result in significant improvements in the quality of services provided to people with dementia and should promote a greater understanding of the causes and consequences of dementia (Box 1). This resonates with our own publication ‘Delirious about Dementia’ and the importance of geriatricians engaging in identifying patients with cognitive impairment, typing the cognitive impairment and referring the sufferer and carer on to support services. The objectives of the NDS can not be faulted and geriatricians must not shirk from their responsibility to be engaged in the process, for dementia is core to our practice whether or not we run a memory service. Whether we are confined to the acute hospital or out in the community, dementia sufferers and their carers will be ever present, the NDS offers us a chance to improve the care of both sufferer and carer. The potential benefits of improved dementia care to the system are: a reduction in the number of crisis admissions; a reduction in the number of delayed discharges; easier transfer of dementia sufferers to care home placement, which in themselves will reduce the costs of dementia care. Surely, just from an acute hospital perspective, the NDS offers an unrivalled opportunity to improve the care of those who are most at risk of a complicated and unnecessarily long hospital stay (any hospital management team that does not recognise this must itself be cognitively impaired!). Of course improving dementia care will not be without cost and so the economic impact of implementing the NDS is modelled over 5 years, i.e. several fiscal spending rounds. So, get engaged, if you aren’t already. Ensure all your patients (inpatients and outpatients) have their cognition assessed; type the cognitive impairment; seek to stop or slow down the rate of cognitive decline (e.g. treat hypothyroidism, modify vascular risk factors, consider cholinesterase inhibitors); refer those with dementia to the appropriate support services; lobby your hospital to develop liaison mental health teams; lobby your acute hospital to improve awareness of delirium and dementia and get your hospital management to understand the financial benefits of so doing; strengthen links with your old age psychiatrists; and work with your PCT(s) to improve the long-term care of care home residents. And remember, you have a 1:4 chance of developing a dementia and a 1:3 chance of caring for someone with dementia, so making the NDS work is in your own interest too! Duncan Forsyth BGS Newsletter, May 2009 |
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