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Dementia and Delirium

In a nutshell: It is understood that patients with dementia and/or delirium are exposed to more patient safety risks than the general population; with increasing numbers of people living with these conditions it is more important than ever to equip staff with the right tools to deliver safe person-centred care.

The improvement Academy is working with experts in caring for people with dementia and delirium, learning what works in practice and how to make sustainable improvements. 

Dementia

Dementia is a disease affecting memory, personality, emotion and behaviour, it is more common in older people although there are estimated to be over 40,000 people with young onset dementia (diagnosis before 65) living in the UK. Alzheimer's disease is the most common cause of dementia but not all dementia is due to Alzheimer's.

The evidence consistently suggests that people with dementia experience poorer health and wellbeing outcomes than their counterparts without the condition.

According to the Alzheimer's Society there are around 800,000 people in the UK with dementia. One in three people over 65 will develop dementia, and two-thirds of people with dementia are women. Total numbers are increasing because people are living longer. It is estimated that by 2021, the number of people with dementia in the UK will have increased to around 1 million.

The treatment of Dementia in the UK costs the UK £26 billion a year, higher than cancer, heart disease or stroke. Around ¼ of hospital beds and 70% of care home places are occupied by people with dementia (Alzheimer's Society, 2009).

Delirium

Delirium (sometimes called 'acute confusional state') is a common clinical syndrome characterised by altered consciousness, cognitive function or perception, which has an acute onset and fluctuating course. It usually develops over 1–2 days. It is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently. (NICE Guidelines July 2010). It is very common, and is estimated that around 30% of older patients will experience delirium during an in-patient episode.

Dementia and delirium may be particularly difficult to distinguish, and a person may have both. In fact, frequently delirium occurs in people with dementia.

Person Centred Care

The work the Improvement Academy is involved in centres around understanding how to use a person centred care approach to make caring for patients with dementia and/or delirium safer and improve patient experience. Person-centred care is still an emerging and evolving area what it looks like will depend on the needs, circumstances and preferences of the individual receiving care. What is important to one person in their health care may be unnecessary, or even undesirable, to another. It may also change over time, as the individual's needs change.

The Health Foundation has identified a framework that comprises four principles of person-centred care:

    1. Affording people dignity, compassion and respect.
    2. Offering coordinated care, support or treatment.
    3. Offering personalised care, support or treatment.
    4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

Areas of work

The Improvement Academy is working with an acute hospital ward to understand the barriers and enablers to providing person centred care especially for patients with dementia and delirium but importantly testing person centre red care principles for all patients.

You can watch the case study describing the impact of work on a delirium unit - Mallard Ward at Doncaster hospital here. 

 

Patient Safety Collaborative

The Patient Safety collaborative can help you to improve the safety of your patients by applying latest evidence based tools for improvement.

Further Information

 

Toolkit aimed at making areas caring for patients with dementia as supportive as possible.

Health Foundation paper with good explanation for person centred care.

 

For more information about the person centred care principles, see Dr Alf Collins' thought paper for the Health Foundation.
www.health.org.uk/publications/measuring-what-really-matters

Impact Case Study:  Watch the video case study describing the impact of work on a delirium unit - Mallard Ward at Doncaster hospital here. 

Blog: Discussing older people and person centred care by Rod Kersh

 

 


 

Jackie Hallam

Jacqueline.Hallam@yhahsn.nhs.uk

01274 383959