Older People with Dementia in Acute Care: Key messages from the NAO report Paul Forte The Balance of Care Group www.balanceofcare.com - PowerPoint PPT Presentation

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Older People with Dementia in Acute Care: Key messages from the NAO report Paul Forte The Balance of Care Group www.balanceofcare.com

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Title: Balance of Care Dementia Author: Dr P.G. Forte Last modified by: Paul Forte Created Date: 8/13/2002 2:07:49 PM Document presentation format – PowerPoint PPT presentation

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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
2
NAO 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

3
A 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
4
The 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

5
The 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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Appropriateness 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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Some 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
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