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Acute/ general hospitals

Diagnosis, post-diagnostic support

Many strategies had a specific focus on some of the health-care considerations related to dementia, with themes including the admission processes, the establishment of psychiatric services or accessibility issues for people with dementia. Some strategies, such as those of Austria and Luxembourg contain a broad commitment to improving the quality of care for people with dementia in general hospitals.

Outpatient clinics/psychiatric services

A number of strategies placed a specific focus on psychiatric services for people with dementia, in one form or another.

The Welsh strategy set out that all general hospitals should have psychiatric liaison services, as well as ensuring the implementation of dementia-specific recommendations from professional clinical bodies.

The Greek strategy proposes the creation of clinics within every general hospital with the aim of providing integrated medical care to people with dementia, whilst noting that such services would need to link in with community-based services to improve access for people, including those in remote areas. Similarly, the Slovenian strategy proposes the creation of two state-led memory centres, with a net- work of regional memory centres, supporting and guiding the development of treatment for people with dementia at the national level.

The Finnish strategy took a similar approach committing to ensuring that hospitals or health catchment areas would have responsibility for establishing specialist medical care for people with dementia, as well as providing support to primary care.

The Cypriot strategy also committed to the creation of specialised memory clinics within hospitals, whilst also setting out the possibility of specific wards/beds for the long-term hospitalisation of people with dementia to monitor the progression of the condition.

The Irish strategy committed to ensuring that, where possible, in the circumstances where a person with dementia required acute admission to a psychiatric unit, a secure placement would be made in a suitable old age psychiatry unit.

In-patient/admission/discharge

Of the strategies which focused on acute care, a number focused on the process of a person’s admission to hospital and the care they received whilst within an acute setting.

Some strategies were primarily concerned with the process of admitting a person with dementia into an acute setting. For example, the German strategic document committed to identifying dementia promptly during or following admission to hospital, with hospitals informed in advance where transfers to acute settings were planned. The Maltese strategy similarly identified the importance of timely high-quality assessment of individuals presenting dementia symptoms in acute general hospitals.

On a similar theme, the Northern Irish strategy included an action for health trusts to review hospital bed provision for dementia assessment to harmonise provision across trusts, with an emphasis on developing assessment services in the community.

The Irish strategy committed to ensuring that hospitals take measures to encourage better recording and coding of a primary or secondary diagnosis of dementia to ensure better recording of admissions, re-admissions, lengths of stay and discharge.

The Greek approach is distinct insofar as it seeks the creation of special examination and treatment protocols for people in general hospitals, admission and the establishment of a doctor with overall coordination responsibility for dementia at every general hospital. Similarly, the Swiss strategy also contained a provision in relation to the development and implementation of recommendations and guidelines for acute care hospitals, with a focus on how adult-protection legislation would be embedded within decision-making processes.

Additionally, the Swiss strategy commits to the provision of services and crisis teams in community settings to reinforce expertise and safeguard quality of treatment, with the intention of fewer people with dementia being inappropriately admitted to hospital. Both the Scottish strategy and German strategic document committed to similar aims, including on delayed discharge, avoidable admissions and inappropriate long stays in hospital, with the latter committing to a national action plan, with the former committing to build on its acute work programme started under the second strategy.

Both the Irish and Maltese strategies also set out the need to ensure that people with dementia have a care plan developed during their hospital stay, addressing the dementia-specific supports and activities necessary to ensure appropriate care in, and timely discharge from, hospital.

Dementia accessibility

A number of strategies additionally recognised that admission to hospital was often difficult for people with dementia and that there is a need for hospitals to adapt environments and practices to become more accommodating for people with dementia.

The German strategic document identified the need for specific provision to be made for people with dementia, including the structure of their day and activities, as well as allowing relatives the option to stay with the person with dementia if it is requested. Similarly, Spain also proposed similar approach for people with dementia both in hospital emergency rooms but also across the wider health system. On the latter point, the Welsh strategy also committed to applying the principles of “John’s Campaign” 1  in acute hospital settings.

The Swiss strategy focused on the promotion of dementia-appropriate care in acute care hospitals which included adapting both infrastructure and processes (including treatment, care and nursing, room design, staff and interface management). Similarly, the Irish strategy commits to hospitals prioritising the assessment of social and environmental supports to meet the needs of people with dementia and their carers.

Focused more on the design and decor of hospitals, the Danish strategy included a commitment to initiating pilot projects in selected regions and hospitals. Similarly, the English national dementia strategy contains a high level commitment to ensuring that all hospitals and care homes meet agreed criteria to become dementia friendly.

This approach was also found within the Irish strategy which committed to the development of guidelines on dementia-friendly ward specification (including safe walking spaces and the use of colour, lighting, signage, orientation cues etc.), which would be taken into account at the design stage of all refurbishments and new builds.

As well as securing an agreement from the German Hospital Federation regarding the incorporation of dementia friendly room design, the German strategic document also commits to the development of information brochures for patients and relatives about the challenges in acute settings.

Other

The Irish strategy contained specific commitments which were not found in other strategies, including the creation and implementation of a dementia and delirium care pathway implemented at a local level in each acute hospital. Similar to the Greek strategy, the Irish strategy also proposes the assignment of a senior clinician within each hospital to lead the development, implementation and monitoring of the pathway.

Additionally, the Irish strategy is the only one which specifically addresses the needs of people with dementia who go through Emergency Departments and Acute Medical Units, proposing to develop a specific pathway.

Footnotes

1     John’s Campaign is a UK-wide campaign which seeks to give carers greater ability to support the person with dementia whilst they are in hospital or care facility.

 

 
 

Last Updated: Monday 29 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
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