Dementia and delirium specialists from University College Hospital London, The Royal London Hospital and Dementia UK came together at the end of February for a special debate on how dementia and delirium should be approached in acute hospital settings. The event was organised by staff from University College Hospital and generated lots of interest.
A sudden change
Delirium is a sudden change in a person’s mental state. It can lead to increased confusion, disorientation, or difficulty with concentration, and can come on very quickly. It can occur when you are medically unwell and can be caused by infections, pain or dehydration.
Both delirium and dementia are of increasing significance in acute hospital settings, in part due to the UK’s ageing population. In hospitals, approximately 20-30% of older people on medical wards will have delirium and up to 50% of people with dementia. Between 10-50% of people having surgery can develop delirium. In addition, older people with delirium and dementia have been found to have longer stays in hospital; be at increased risk of complications such as falls, accidents or pressure sores; and be more likely to be admitted into long-term care.
The event panellists highlighted the success and investment which has led to significant improvements in the way hospitals care for people with dementia, including initiatives such as the RCN SPACE principles, Dementia Friendly Hospital Charter and previously the National Service Framework for Older People (2001).
A question of priority
During the debate the question was raised whether dementia or delirium should be given greater priority in an acute hospital environment, particularly given the limited resources available.
Daniel Davis, Honorary Consultant Geriatrician and Senior Clinical Researcher UCLH/UCL said: “Delirium is important because it is the most catastrophic, combination of pre-existing cognitive impairment. Of course we would like to work better with dementia and that requires working in cross-settings, working better with community mental health, working better with general practice. The story doesn’t just begin in hospital and it doesn’t just end with discharge.
Dementia UK’s Professional & Practice Development Lead Rachel Thompson, who was also on the debate panel, said: “It’s important that we take a holistic approach to care as well as work to increase awareness of delirium, especially for those with dementia who are often more at risk. Delirium is a treatable condition and may co-exist with dementia. We need to get better at recognising and treating delirium, dementia but also depression. Dementia specialists, including Admiral Nurses, have the right approach and knowledge and can work with generalist staff to improve understanding and delivery of care.”
The event was hosted by University College Hospital and run by The Older Adult Assessment Team. Also on the panel were Liz Sampson, Consultant in Liaison Psychiatry, Division of Psychiatry at University College London and Sophie Edwards, Consultant Elderly Medicine at The Royal London Hospital.