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Dementia and the Acute Hospital

Dementia and the Acute Hospital. Dr DN Carmichael Consultant Geriatrician Royal Liverpool Hospital. Why are there problems Elective Events Emergency Care Capacity and consent. Journey’s full of adventure. The Acute Hospital. Why should there be a problem?. The patient Memory

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Dementia and the Acute Hospital

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  1. Dementia and the Acute Hospital Dr DN Carmichael Consultant Geriatrician Royal Liverpool Hospital

  2. Why are there problems • Elective Events • Emergency Care • Capacity and consent

  3. Journey’s full of adventure

  4. The Acute Hospital

  5. Why should there be a problem? The patient • Memory • Executive function • Visuo-spatial function • Rigidity of thinking • Insight • Familiarity / routine The hospital • Awareness • Time poor • Target driven • Pathways • Assumptions

  6. Why should there be a problem? • Disorientation • “Delirium on dementia” • Hypoxia • Mind altering drugs • Sleep deprivation • Dehydration • Sepsis

  7. ConflictPerception, need and their interaction • What does the patient need? • How do they see the situation? • Can they communicate? • Can they cooperate?

  8. Conflict • What do the staff need to do? • What can they do? • What cannot be done? • What limits their action

  9. Emergency or elective Elective • Clinic visits • Elective procedures (surgery , endoscopy, x-ray) • PAMS ( physiotherapy, occupational therapy) Emergency • Emergency admission via AED • Admission via GP • Crisis response

  10. Elective events

  11. Patients and elective eventsThe normal journey • Making and remembering appointment • Get to the hospital • Moving within the hospital environment • Communicate with staff • Function within a strange environment • Get home again

  12. Patients and elective events Making and remembering appointment Have you tried using choose and book? A touch phone choice System? Getting to hospital Ambulance transport. Be ready on time! Moving within the hospital environment Find a ward? Find a nurse?

  13. Patients and elective events Communicating with staff Information is needed quickly. Many events now pathway driven. Functioning within a strange environment Strange ward, strange people, constant change Getting home again Day case surgery requires recovery time. Transport

  14. Carers and Elective events • Who are you? • Why are you here? • Why will no one tell me? • You can’t stay here, it’s health and safety / against the law! • “Does he take sugar?”

  15. Hospital Staff and Elective events • Time pressure ( especially with increased day case work) • Pathways • Training • Other patients

  16. Emergency Events

  17. Acute / emergency events The normal journey • See GP or call ambulance • Travel to AED /AMU/ SAU • Triage • History examination by doctor. (Blood tests / X-rays ECG etc) • Treatment ( Medication or surgery) • Senior Review • Admission • Further Treatment assessment • Discharge planning

  18. Why should there be a problem? See GP or call ambulance. • Delayed recognition of problem • Communication • Strangers Travel to AED /AMU/ SAU • Ambulance environment • Admission process • Memory • Executive function • Visuo-spatial function • Rigidity of thinking • Insight • Familiarity / routine

  19. Why should there be a problem? Triage • Quick questioning and assessment History & examination (Blood tests / X-rays ECG etc) • A stranger • Personal questions • Physical contact • Pain • Memory • Executive function • Visuo-spatial function • Rigidity of thinking • Insight • Familiarity / routine

  20. Why should there be a problem? Treatment • Consent • Capacity • Cooperation • Side effects Senior Review • Communication • Planning • Memory • Executive function • Visuo-spatial function • Rigidity of thinking • Insight • Familiarity / routine

  21. Why should there be a problem? Admission- the Ward • Environment • People • Equipment • Noise • Drug effects • Delirium • Memory • Executive function • Visuo-spatial function • Rigidity of thinking • Insight • Familiarity / routine

  22. The other side of the same journey • What if they are the relative?

  23. Capacity and Consent • All adults are assumed to have capacity unless there is proof to the contrary • Capacity is decision specific • Common law • The “Mental Capacity Act” • Deprivation of Liberty Standards

  24. Discharge Planning • Information • Insight • Family involvement • Acceptable and accepted services.

  25. Did you have a good journey?

  26. Questions? Thank you

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