Title: Older People with Dementia in Acute Care: Key messages from the NAO report Paul Forte The Balance of Care Group www.balanceofcare.com
1 Older People with Dementia in Acute CareKey
messages from the NAO reportPaul ForteThe
Balance of Care Groupwww.balanceofcare.com
2NAO dementia study aims
- Set out the overall impacts of dementia in older
people on the economy - research national surveys of GPs and CMHTs,
- local whole system study - Lincolnshire
- focus groups and web forum for people with
dementia and their carers - Recommend improvements to support for people with
dementia and their carers to enable them to
maintain good physical and mental health - Recommend ways of reducing cost and duplication
- Provide an overall value for money assessment for
Parliament and taxpayers
3A whole system perspective
Pre admission
Pre admission
Admission
Diagnosis
Treatment
Discharge
Re-admission
Social details alone, carers, residence Risk
factors age, drugs, co-morbidities, psychiatric/
dementia, falls Preventative care Disease
managementManaged populations
Source of referral Time Waiting
time Route Decision maker Reason for
admission Alternatives to acute admission setting
Discharge planning Delays in planning Delays in
execution Alternative sites for discharge
Admission diagnosis Inpatient diagnosis Delays in
diagnosis Chronic disease Alternative access
for diagnosis
Delays in therapy Alternative settings for
therapy (especially rehab)
Revolving door Avoidable e.g. chronic disease
management Alternative sites for readmission
4The Lincolnshire bed usage survey
- To identify the number and types of inpatients
currently receiving hospital care (acute and
non-acute) who might potentially have - been treated elsewhere and avoided admission
- required admission, but could now be treated
elsewhere - particular emphasis on people with dementia
5The Lincolnshire bed usage survey
- To identify the number and types of inpatients
currently receiving hospital care (acute and
non-acute) who might potentially have - been treated elsewhere and avoided admission
- required admission, but could now be treated
elsewhere - particular emphasis on people with dementia
- Point prevalence survey on 29 November 2006
- All medical and orthopaedic inpatients (667)
- All intermediate care inpatients (121)
- All OPMH inpatients (75)
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13Appropriateness Evaluation Protocol
- On admission
- Severity of illness
- eg unconscious, unable to move (fall), acute
bleeding - Intensity of service
- eg surgery general anaesthesia, regular
monitoring, IV therapy - On day of care
- Medical services
- Nursing services
- Patient condition
- eg acute confusion, other acute states, coma,
fever
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18Some Key Points
- 111 out of 863 patients surveyed (13) had a
recorded dementia diagnosis - 65 were in acute hospital
- There may be substantial under-diagnosis or
under-recording of dementia - Majority of acute hospital patients with dementia
were outside AEP criteria on the day of the
survey - Potential alternative care settings cover a wide
range of services specialist coordination may be
needed - Demand for rehab support for people with dementia