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Dementia costs the UK more than cancer, heart disease and stroke put together, and the number of people affected is on the increase, in line with the increase in population.

 The majority of people with dementia are older people who live in the community and about half of them have never been diagnosed, so every health service facility that receives patients will receive a significant number of people every day who have undiagnosed dementia.
The problems associated with this are well known to frontline staff.  Firstly, people with dementia are more likely to have an adverse incident in an acute hospital than other patients, so their presence gives rise to unexpected morbidity with associated increase cost and length of stay.  Secondly, they are much more likely to develop delirium than other patients, and the consequences for them can be fatal.  This again gives rise to resource issues.

The most significant and third point is that the systems of acute hospitals, which are challenging enough if patients are young and fit and having elective treatment, are really badly designed for people with dementia.  This includes everything from the fact that staff usually have no dementia training, the condition is not well spotted and cared for, the environment is particularly badly designed from the point of view of patients with dementia and the speed of treatment really requires the patient to be on the ball and quite able to contribute a lot to their own care.

An example of this is the frequency with which people with dementia in hospital don’t get enough to eat and drink, because they can’t express their preferences or be given the time and support needed to help them cope with packaged, unfamiliar food presented in airline style trays in an environment that is more like a battle zone than a dining room.  The noise of bleeps, phones and monitors; the endless stream of new faces; the incomprehensible interventions of the staff rushing round – all of this gives rise to a sharp increase in the impairments that are present in dementia.
The hospital environment and the pressure for speed is not something that can be tackled in its entirety, but there are simple measures that can be taken that will considerably reduce the dangers of that environment for the person with dementia, and thus the avoidable cost to them, and the system of an acute admission.

Some simple interventions include:

•    Increase light levels, have a visible clock, label the toilets so they are easy to find, reduce needless noise like unwatched TVs,

•    Get staff to introduce themselves every time they do something, even when returning after a few minutes, and to use clear communication, and be aware of their non verbal communication

•    Attend to hydration obsessively, understand how to overcome reluctance to accept food and pain relief, prevent constipation and mobilise people as if their life depends on it.