I think we all agree that hospitals are the worst place for people living with the Big D to spend time.
Unfamiliar surroundings filled with strangers trying to talk to you are challenging situations to deal with at the best of times, let alone in a busy clinical environment. “Where am I?, who are you?, leave me alone, get off me” will be all too familiar comments made to hospital teams when treating patients with dementia. For the purpose of this blog I’m going to call them D-patients.
I realise that in certain circumstances there’s no alternative to a hospital admission. However, I’m sure we all agree that this needs to be kept to an absolute minimum for D-patients.
|This is why I was saddened to read the recent Public Health England report titled “Older people’s hospital admissions in the last year of life”.|
|Older people are classed as 75 years and older. According to the report the largest total number of days spent in hospital (1,760,801 days) was in people who died from an underlying or contributory cause of death of dementia (see bottom chart).|
|As far as I can gather we need to address three issues here. Firstly, reduce the number D-patient admissions. Secondly, discharge them sooner into the safety and comfort of the place they know as home. And finally, reduce the number of D-patients passing away in hospitals.|
As you can see most admissions for D-patients are emergencies. My experience as a carer leads me to believe that a large number of these admissions will have been as a result of a trip, slip or fall at home. Emergency services will probably have been involved.
In order to make my point, I’m going to share a harrowing incident I witnessed during my early days as a carer when an elderly man fell at home. His wife was too frail to pick him up. He was in a state of undress. When the ambulance arrived they couldn’t lift him safely. They called for more assistance. In the end three ambulances were on site and he was carried down the stairs using a bed sheet. You can imagine the distress this caused.
Three days after being discharged the gentleman had another fall in his bathroom and was hospitalised again. He never got the chance to live at home again as he was discharged into a nursing home. He died soon after.
The outcomes could have been so much better had the necessary adjustments been made to his home.
He would have lived longer, safer and independently in his own home that he adored so much. There would have been fewer emergency interventions, hospital admissions and number of days spent in an environment that caused him so much distress.
So my main point is that we all need to work much harder on keeping people living with dementia safe and secure in their own homes for longer. With the necessary adjustments to their living space this can be achieved.
If we achieve this then the outcomes will be fewer D-patient admissions, quicker discharges and more people spending their last year of life in their own home.
Imagine the positive outcomes for D-patients and the NHS if we reduced the 1.7 million hospital days by a third. Believe me, it’s achievable if we get the right primary and preventative measures in place when families first receive their dementia diagnosis.
We all know how distressing hospital stays are for D-patients. That’s why reducing the days spent in hospital is such an integral part of my D-plan.