Managing people with dementia in the general hospital

David Ames, John T. O’Brien, Alistair Burns

in Dementia

In the United Kingdom, older people with dementia occupy a quarter of the general hospital beds (Alzheimer’s Society, 2009). One out of three emergency medical admissions is of an older person with cognitive impairment; someone with dementia is up to four times more likely to be admitted as an emergency case than someone without (Goldberg et al., 2012) and severity of dementia independently predicts hospitalization (Albert et al., 1999). Arguably, dementia now represents ‘core business’ for general hospital clinical practices.

Case 81: Delirium and Tachypnoea

Kerry Layne

in 100 Diagnostic Dilemmas in Clinical Medicine

An 82-year-old man presented to the emergency department complaining of shortness of breath on exertion, orthopnoea and wheeze. He was a vague historian and was clearly very confused. He did tell the team that he was an ex-smoker, had previously consumed alcohol to excess, and thought that his general practitioner (GP) had stopped a ‘water tablet’ over the preceding month. Documents on the trust electronic patient record system showed that he had a past history of atrial fibrillation, hypertension, angina and vascular dementia, but no further medical records were available. There were no details for a next-of-kin from whom to take a more complete history. It was a Friday evening and the emergency department team was therefore unable to contact the patient’s GP.

Maintaining boundaries

Sandra Evans, Jane Garner, Rachel Darnley Smith

in Psychodynamic Approaches to the Experience of Dementia

The maintenance of boundaries and a suitable therapeutic space is one of the cornerstones of psychoanalytic practice (Maciver and Russ, 2014). However, when working with older adults – particularly those who are frail or who have mobility difficulties or cognitive impairment – an element of flexibility is helpful. Some people may not be able to attend an outpatient clinic or a therapists’ consulting room and, in order that these people are not discriminated against, we should change our practice to enable them to be seen. However, this brings its own challenges and maintaining a safe space for the consultation to take place may be difficult. In this chapter we will discuss the unusual case of a woman seen for counselling in a care home and the issues which it raises for those of us who offer a service to older adults. Although this client did not have dementia, she was affected by it in a significant but largely unacknowledged way through living in a unit which was largely a dementia-specific facility and where the staff and management were understandably focussing on the primary resident group. The “plight” of the elderly person with intact cognitive abilities living in such a setting does not appear to get therapeutic attention.

Dementia enquirers: pioneering approaches to dementia research in UK

Published in Disability & Society

Teresa DaviesAgnes HoustonHoward GordonMhari McLintockWendy MitchellGeorge RookTom Shakespeare

This paper explores the Dementia Enquirers approach to dementia research, and the 10 local projects which have been funded in the first wave of the programme. The paper is written by six people with dementia with expertise by experience, supported by a traditional academic with expertise by research. This co-production enables the voices of people with dementia to be heard, and expands the field of disability studies. The authors discuss problems with traditional academic research, and the different ways that people with dementia go about research. Two examples of research projects led by people with dementia are discussed. The paper explores difficulties people with dementia have had with formal research ethics procedures and how they propose to do things differently. In conclusion, the authors challenge mainstream dementia research to do things differently, and to understand the potential contributions of people with dementia.

Association between having a family member with dementia and perceptions of dementia preventability

Published in Aging & Mental Health

Woojung LeeShelly L. GrayOleg ZaslavskyDouglas BartholdZachary A. Marcum 

One’s experience with dementia may affect their perceptions about dementia preventability, which in turn could influence preventive health behaviors. We aimed to examine how having a family history of dementia and caregiving experience are associated with perceptions about and self-efficacy for dementia preventability. Cross-sectional, self-administered survey. Participants reported whether they have had a family member with dementia and, among those who reported having a family member with dementia, whether they served as a caregiver. Outcomes were perceptions about the likelihood of dementia preventability, self-efficacy for dementia prevention, and benefits of specific dementia prevention strategies. Associations were assessed via partial proportional odds model for ordinal outcome variables and logistic regression for binary outcome variables. Of 1,575 respondents, 71% had a family member with dementia, of which 42% served as a caregiver.

The effects of caregiver characteristics on behavioral and psychological symptoms of dementia of patients with dementia

Published in Aging & Mental Health

Pei-Chao LinHui-Tzu LinYu-Hsiang YangYuan-Han Yang

To determine the association between caregiver characteristics and behavioral and psychological symptoms of dementia (BPSD) in patients with dementia (PWD) in a Taiwanese community-dwelling population. This cross-sectional study was conducted using the data of 190 patients with Alzheimer’s disease/dementia and 190 informal matched caregivers in Taiwan. BPSD were examined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were used to explore associations between caregiver characteristics and the presence, severity, and distress of NPI-Q items. Only spouse primary caregiver was positively associated with presence of delusions in PWD. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference in PWD, while child primary caregiver was positively related to severity of disinhibition in PWD but negatively related to severity of anxiety in PWD. Spouse primary caregiver was positively related to severity of anxiety and appetite/eating in PWD while sole primary caregiver was positively related to severity of anxiety and nighttime behaviors in PWD.