Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T09:35:08.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment and management of dementia in the general hospital setting

Published online by Cambridge University Press:  17 July 2014

Inderpal Singh ,
Amrita Varanasi  and
Kathryn Williamson
Inderpal Singh*
Affiliation:
Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach, UK
Amrita Varanasi
Affiliation:
Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Ystrad Mynach, UK
Kathryn Williamson
Affiliation:
Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Ystrad Mynach, UK
*
Address for correspondence: Dr Inderpal Singh, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach CF82 7GP, UK. Email: inder.singh@wales.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Populations are ageing worldwide. The prevalence of dementia will rise exponentially with the oldest old the most rapidly growing segment of society. Caring for this ageing population with dementia, many of whom will have multiple chronic and disabling diseases, will be a challenge to healthcare systems, particularly general hospitals. At any one time, a quarter of acute hospital beds in the UK are in use by people with dementia. Delivery of high-quality care to this growing and vulnerable population must be high on any health service agenda.

Current medical training not only generates relatively low numbers of geriatricians and specialists with interest in dementia, but also there is a lack of appropriate training in assessment and management of dementia. There remains huge need for better staff training and support to provide safe, holistic and dignified dementia care. Here we explore various key features for non-specialist assessment and management of older people with dementia in the general hospital setting.

Keywords

agedsecondary carefunctionco-morbiditycognitiondementia
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 3 , August 2014 , pp. 205 - 218
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1World Alzheimer Report 2009: The Global Prevalence of Dementia. Alzheimer's Disease International; 2009. Available at: http://www.alz.co.uk/research/files/WorldAlzheimerReport.pdf (accessed 19 February 2014).Google Scholar
2Living Well with Dementia: A National Dementia Strategy. London: Department of Health; 2009. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/168220/dh_094051.pdf (accessed 19 February 2014).Google Scholar
3NICE quality standard for supporting people to live well with dementia: information for the public; 2013. Available at: http://www.nice.org.uk/nicemedia/live/14141/63423/63423.pdf (accessed 6 February 2014).Google Scholar
4Stuck, AE, Siu, AL, Wieland, GD, Adams, J, Rubenstein, LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–36.Google Scholar
5Young, J, Hood, C, Gandesha, A, Souza, R. Royal College of Psychiatrists (2013). National Audit of dementia care in general hospitals 2012–13: Second round audit report and update. London: HQIP. Available at: https://www.rcpsych.ac.uk/pdf/NAD%20NATIONAL%20REPORT%202013.pdf (accessed 19 February 2014).Google Scholar
6Department of Health. Policy for improving care for people with dementia; 2013. Available at: www.gov.uk/government/policies/improving-care-for-people-with-dementia (accessed 21 February 2014).Google Scholar
7Chinthapalli, K.Reward doctors for early diagnosis of dementia, says think tank. BMJ 2012; 345: e8533CrossRefGoogle ScholarPubMed
8World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Alzheimer's Disease International; 2011. Available at: http://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf (accessed 19 February 2014).Google Scholar
9Getsios, D, Blume, S, Ishak, KJ, Maclaine, G, Hernandez, L. An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimer Dementia 2012; 8: 22–30.Google Scholar
10Le Couteur, DG, Doust, J, Creasey, H, Brayne, C. Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis. BMJ 2013; 347: f5125.Google Scholar
11Sampson, EL, Blanchard, MR, Jones, L, Tookman, A, King, M. Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 2009; 195: 61–66.Google Scholar
12Marengoni, A, Nobili, A, Romano, Vet al.Adverse clinical events and mortality during hospitalization and 3 months after discharge in cognitively impaired elderly patients. J Gerontol A Biol Sci Med Sci 2013; 68: 419–25.Google Scholar
13Matthews, FE, Arthur, A, Barnes, LEet al.A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013; 382: 1405–12.Google Scholar
14Alzheimer's Society. Dementia 2013 infographic. Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=2164 (accessed 7 February 2014).Google Scholar
15Brayne, C, Fox, C, Boustani, M. Dementia screening in primary care: is it time? JAMA 2007; 298: 2409–11.Google Scholar
16Brunet, MD, McCartney, M, Heath, Iet al.There is no evidence base for proposed dementia screening. BMJ 2012; 345: e8588.CrossRefGoogle ScholarPubMed
17US Preventive Services Task Force. Screening for dementia: Recommendations and rationale. Ann Intern Med 2003; 138: 925–26.Google Scholar
18Kansagara, D, Freeman, M. A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA. VA-ESP Project #05–225; 2010.Google Scholar
19Grand, JHG, Caspar, S, MacDonald, SWS. Clinical features and multidisciplinary approaches to dementia care. J Multidiscip Health 2011; 4: 125–47.Google Scholar
20Hooker, K, Bowman, SR, Coehlo, DPet al.Behavioral change in persons with dementia: relationships with mental and physical health of caregivers. J Gerontol B Psychol Sci Soc Sci 2002; 57: 453–60.CrossRefGoogle ScholarPubMed
21Ballard, CG, Patel, A, Solis, M, Lowe, K, Wilcock, G. A one-year follow-up study of depression in dementia sufferers. Br J Psychiatry 1996;168: 287–91.Google Scholar
22Burns, A, Lewis, G, Jacoby, R, Levy, R. Factors affecting survival in Alzheimer's disease. Psychol Med 1991; 21: 363–70.Google Scholar
23Nagahama, Y, Okina, T, Suzuki, N, Matsuda, M, Fukao, K, Murai, T. Classification of psychotic symptoms in dementia with Lewy bodies. Am J Geriatr Psychiatry 2007; 15: 961–67.CrossRefGoogle ScholarPubMed
24Inouye, SK, Zhang, Y, Han, L, Leo-Summers, L, Jones, R, Marcantonio, E. Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J Gen Intern Med 2006; 21: 1276–81.CrossRefGoogle ScholarPubMed
25Fong, TG, Jones, RN, Marcantonio, ERet al.Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 2012; 156: 848–56.Google Scholar
26British Geriatrics Society. Comprehensive assessment of the frail older patient; 2010. Available at: http://www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/195-gpgcgassessment (accessed 23 February 2014).Google Scholar
27Ellis, G, Langhorne, P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005; 71: 45–59.Google Scholar
28Inouye, SK, van Dyck, CH, Alessi, CA, Balkin, S, Siegal, A, Horwitz, RI. Clarifying confusion: the confusion assessment method. Ann Intern Med 1990; 113: 941–48.Google Scholar
29Ramage-Morin, PL. Medication use among senior Canadians. Health Rep 2009; 20: 37–44.Google Scholar
30Morgan, TK, Williamson, M, Pirotta, M, Stewart, K, Myers, SP, Barnes, J. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust 2012; 196: 50–53.CrossRefGoogle ScholarPubMed
31Hilmer, SN, Gnjidic, D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009; 85: 86–88.Google Scholar
32Jyrkkä, J, Enlund, H, Korhonen, MJ, Sulkava, R, Hartikainen, S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging 2009; 26: 1039–48.Google Scholar
33Taylor, ME, Lord, SR, Delbaere, K, Mikolaizak, AS, Close, JC. Physiological fall risk factors in cognitively impaired older people: a one year prospective study. Dement Geriatr Cogn Disord 2012; 34: 181–89.CrossRefGoogle ScholarPubMed
34Banerjee, S. The use of antipsychotic medication for people with dementia: time for action; 2009. Available at: http://www.rcpsych.ac.uk/pdf/Antipsychotic%20Bannerjee%20Report.pdf (accessed 10 March 2014).Google Scholar
35Hartikainen, S, Lonnroos, E, Louhivuori, K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 2007; 62: 1172–81.Google Scholar
36von Moltke, LL, Greenblatt, DJ, Romach, MK, Sellers, EM. Cognitive toxicity of drugs used in the elderly. Dialogues Clin Neurosci 2001; 3: 181–90.CrossRefGoogle ScholarPubMed
37Milton, JC, Hill-Smith, I, Jackson, SHD. Prescribing for older people. BMJ 2008; 336: 606–9.Google Scholar
38Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW. Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–19.Google Scholar
39Erkinjuntti, T, Hokkanen, L, Sulkava, R, Palo, J. The blessed dementia scale as a screening test for dementia. Int J Geriat Psychiatry 1988; 3: 267–73.CrossRefGoogle Scholar
40Lawton, MP, Brody, EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179–86.Google Scholar
41Pfeffer, RI, Kurosaki, TT, Harrah, CH, Chance, JM, Filos, S. Measurement of the functional activities in older adults in the community. J Geront 1982; 37: 323–29.Google Scholar
42Sclan, SG, Reisberg, B. Functional assessment staging (FAST) in Alzheimer's disease: reliability, validity and ordinality. Int Psychogeriatr 1992; 4 (suppl 1): 55–69.Google Scholar
43Mahoney, FI, Barthel, DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61–65.Google Scholar
44Galasko, D, Bennet, D, Sano, Met al.An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997; 11: s33–39.Google Scholar
45Gélinas, I, Gauthier, L, McIntyre, M, Gauthier, S. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occup Ther 1999; 53: 471–81.Google Scholar
46Bucks, RS, Ashworth, DL, Wilcock, GK, Siegfried, K. Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. Age Ageing 1996; 25: 113–20.CrossRefGoogle ScholarPubMed
47Juva, K, Mäkelä, M, Erkinjuntti, Tet al.Functional assessment scales in detecting dementia. Age Ageing 1997; 26: 393–400.Google Scholar
48Ballard, CG, Shaw, F, Lowery, K, Mckeith, I, Kenny, R. The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord 1999; 10: 97–103.Google Scholar
49Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–7.Google Scholar
50Allan, LM, Ballard, CG, Rowan, EN, Kenny, RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE 2009; 4: e5521. doi:10.1371/journal. pone.0005521Google Scholar
51Härlein, J, Dassen, T, Halfens, RJ, Heinze, C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs 2009; 65: 922–33.Google Scholar
52Kobayashi, N, Kusuma Wati, DN, Yamamoto, M, Sugiyama, T, Sugai, Y. Severity of dementia as a risk factor for repeat falls among the institutionalized elderly in Japan. Nurs Health Sci. 2009; 11: 388–96.Google Scholar
53Whitney, J, Close, JC, Jackson, SH, Lord, SR. Understanding risk of falls in people with cognitive impairment living in residential care. J Am Med Dir Assoc. 2012; 13: 535–40Google Scholar
54Salva, A, Roque, M, Rojano, Xet al.Falls and risk factors for falls in community-dwelling adults with dementia (NutriAlz trial). Alzheimer Dis Assoc Disord 2012; 26: 74–80.Google Scholar
55Suttanon, P, Hill, K, Said, CM, Dodd, KJ. Can balance exercise programmes improve balance and related physical performance measures in people with dementia? A systematic review. Eur Rev Aging Phys Act 2010; 7: 13–25.Google Scholar
56Hauer, K, Schwenk, M, Zieschang, T, Essig, M, Becker, C, Oster, P. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 8–15.Google Scholar
57Shaw, FE, Bond, J, Richardson, DAet al.Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ 2003; 326: 73.Google Scholar
58Stenvall, M, Olofsson, B, Lundstrom, Met al.A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 2007; 18: 167–75.Google Scholar
59van Doorn, C, Gruber-Baldini, AL, Zimmerman, Set al.Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003; 51: 1213–18.Google Scholar
60Tinetti, ME, Baker, DI, McAvay, Get al.A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821–27.Google Scholar
61Chalmers, J, Pearson, A. Oral hygiene care for residents with dementia: a literature review. J Adv Nurs 2005; 52: 410–19.Google Scholar
62Kayser-Jones, J, Bird, WF, Paul, SM, Long, L, Schell, ES. An instrument to assess the oral health status of nursing home residents. Gerontologist 1995; 35: 814–24.Google Scholar
63Chalmers, JM, King, PL, Spencer, AJ, Wright, FA, Carter, KD. The oral health assessment tool – validity and reliability. Aust Dent J 2005; 50: 191–19.Google Scholar
64Lin, FR, Metter, E, O’Brien, RJ, Resnick, SM, Zonderman, AB, Ferrucci, L. Hearing loss and incident dementia. Arch Neurol 2011; 68: 214–20.Google Scholar
65Allen, NH, Burns, A, Newton, Vet al.The effects of improving hearing in dementia. Age Ageing. 2003; 32: 189–93.Google Scholar
66Corbett, A, Husebo, B, Malcangio, Met al.Assessment and treatment of pain in people with dementia. Nat Rev Neurol 2012; 8: 264–74.CrossRefGoogle ScholarPubMed
67Achterberg, WP, Pieper, MJ, van Dalen-Kok, AHet al.Pain management in patients with dementia. Clin Interv Aging 2013; 8: 1471–82.Google Scholar
68Kovach, CR, Noonan, PE, Griffie, J, Muchka, S, Weissman, DE. The assessment of discomfort in dementia protocol. Pain Manag Nurs 2002; 3: 16–27.Google Scholar
69Elia, M. Screening for malnutrition: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool (MUST) for adults. Malnutrition Advisory Group (MAG), a Standing Committee of BAPEN. Redditch, Worcs: BAPEN; 2003.Google Scholar
70Riviere, S, Gillette-Guyonnet, S, Andrieu, Set al.Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's disease. Int J Geriatr Psychiatry 2002; 17: 950–55.Google Scholar
71Røsvik, J, Kirkevold, M, Engedal, K, Brooker, D, Kirkevold, . A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study. Int J Older People Nurs 2011; 6: 227–36.Google Scholar
72Mental Capacity Act 2005 (UK). Code of Practice. Issued by the Lord Chancellor on 23 April 2007 in accordance with sections 42 and 43 of the Act. Available at: http://www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/@disabled/documents/digitalasset/dg_186484.pdf (accessed 10 March 2014).Google Scholar
73Downs, M. Dementia in a socio-cultural context: an idea whose time has come. Ageing Society 2000; 20: 369–75.Google Scholar
74Jackson, TA, Wilson, D, Sheehan, B. Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments. Age Ageing 2013; 42: 689–95.Google Scholar
75Davis, DH, Muniz Terrera, G, Keage, Het al.Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135: 2809–16.Google Scholar
76Fong, TG, Jones, RN, Shi, Pet al.Delirium accelerates cognitive decline in Alzheimer disease. Neurology 2009; 72: 1570–75.Google Scholar
77Witlox, J, Eurelings, LS, de Jonghe, JF, Kalisvaart, KJ, Eikelenboom, P, van Gool, WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010; 304: 443–51.Google Scholar
78Robinson, TN, Raeburn, CD, Tran, ZV, Angles, EM, Brenner, LA, Moss, M. Post-operative delirium in the elderly: risk factors and outcomes. Ann Surg 2009; 249: 173–78.Google Scholar
79Lundstrom, M, Edlund, A, Bucht, G, Karlsson, S, Gustafson, Y. Dementia after delirium in patients with femoral neck fractures. J Am Geriatr Soc 2003; 51: 1002–6.Google Scholar
80Girard, TD, Jackson, JC, Pandharipande, PPet al.Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38: 1513–20.Google Scholar
81Foltynie, T, Brayne, CE, Robbins, TW, Barker, RA. The cognitive ability of an incident cohort of Parkinson's patients in the UK. The CamPaIGN study. Brain 2004; 127: 550–60.Google Scholar
82Goldman, JG, Litvan, I. Mild cognitive impairment in Parkinson's disease. Minerva Med 2011; 102: 441–59.Google Scholar
83Wang, Q, Zhang, Z, Li, L, Wen, H, Xu, Q. Assessment of cognitive impairment in patients with Parkinson's disease: prevalence and risk factors. Clin Interv Aging 2014; 9: 275–61.Google Scholar
84Aarsland, D, Andersen, K, Larsen, JP, Lolk, A, Kragh-Sorensen, P. Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. Arch Neurol 2003; 60: 387–92.Google Scholar
85Pendlebury, ST, Rothwell, PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009; 8: 1006–18.Google Scholar
86‘This is me’, Alzheimer's Society. Available at: http://alzheimers.org.uk/site/scripts/download_info.php?fileID=1604 (accessed 27 February 2014).Google Scholar
87Crabtree, J, Mack, J. Developing champions to enhance the care of people with dementia in general hospitals. Nurs Times 2010; 106: 13–14.Google Scholar
88Singh, I, Ramakrishna, S, Williamson, K. The Rapid Assessment Interface and Discharge service and its implications for patients with dementia. Clin Interv Aging 2013; 8: 1101–8.Google Scholar
89A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care; 2007. Available at: http://www.nice.org.uk/nicemedia/pdf/CG42Dementiafinal.pdf (accessed 11 March 2014).Google Scholar
90Laurila, JV, Pitkala, KH, Strandberg, TE, Tilvis, RS. Detection and documentation of dementia and delirium in acute geriatric wards. Gen Hosp Psychiatry 2004; 26: 31–35.Google Scholar
91Crowther, J, Wilson, KC, Horton, S, Lloyd-Williams, M. Palliative care for dementia – time to think again? QJM 2013; 106: 491–94.Google Scholar
92McCarthy, M, Addington-Hall, J, Altmann, D. The experience of dying with dementia: a retrospective study. Int J Geriatr Psychiatry 1997; 12: 404–9.Google Scholar
93Perrels, AJ, Fleming, J, Zhao, Jet al.Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over. Palliat Med 2014; 28: 220–33.Google Scholar
94Singh, I, Hubbard, RE. Teaching and learning geriatric medicine. Rev Clinl Gerontol 2011; 21: 180–92.Google Scholar
95Diachun, LL, Hillier, LM, Stolee, P. Interest in geriatric medicine in Canada: how can we secure a next generation of geriatricians? J Am Geriatr Soc 2006; 54: 512–19.Google Scholar
96Hughes, NJ, Soiza, RL, Chua, M, Hoyle, GE, MacDonald, A, Primrose, WR, Seymour, DG. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc 2008; 56: 334–38.Google Scholar
97How ageist is Britain? London: Age Concern England, 2005. Available at: http://kar.kent.ac.uk/24312/1/HOWAGE∼1.PDF (accessed 11 March 2014).Google Scholar