Dementia must become a key issue in all health-relevant fields
The number of people with dementia is increasing and with it the number of people with dementia in hospital care. MyHandicap has spoken with Dr Andreas Studer, director of the psychogeriatric department at the Swiss University Center for Medicine of Aging and Rehabilitation of the Felix-Platter Hospital in Basel, Switzerland, about the many challenges that need to be addressed.
MyHandicap: Dr Studer, as a consequence of the demographic evolution, more and more people with dementia need to be treated in hospitals or clinics. How do you assess the challenges that hospitals are faced with?
Dr Andreas Studer: This a major challenge. According to the National Dementia Strategy (project based in Switzerland), aroungd 50 000 people with dementia are treated each year in Swiss hospitals. Also, these numbers will increase, considering that as a result of demographic changes, there are more and more people aged over 80. The prevalence rates for dementia increase dramatically for the people aged 65 and over. Further, people of an advanced age are often multi-morbid, which means they are affected by a number of illnesses. This in turn increases the risk of needing to be treated in a hospital.
MyH: What are the greatest challenges faced by hospitals?
AS: We are dealing with various levels of challenges. One of them is the difficulty to establish a diagnosis. Indeed, people with dementia often have difficulty to assess their own “dementia-related” situation and cannot explain what they are suffering from. They often cannot find the words to describe their symptoms. In such situations, family members or those standing close can often provide valuable additional information.
In terms of therapy, we often involve close family members in decision-making processes. For some patients, various therapeutic approaches can be quite overwhelming – such as, in the case of cancer treatment, radiation or surgery. We try to find out what the patient is able to do, how the treatments can be adapted to his situation, etc. According to the illness and the stage it is at, we also take into consideration whether any form of therapy still makes sense. If the benefits are marginal, we may decide not to proceed with the therapy.
The situation is challenging for the medical as well as for the nursing staff. People with dementia need information that is adapted to their needs, and this information often needs to be repeated as well as be written or presented in such a way that the patient can understand it. In a nutshell, this means more time and a more intensive follow-up.
MyH: Most patients do not come to the hospital because of dementia, but because they may have fallen or become sick. As a result, hospitals also need to treat acute health problems. Which risks are the patients faced with, when dementia moves in the background because other ailments need to be treated more urgently?
AS: When dementia is not taken into account, the diagnosis as well as the therapy cannot be adapted to the specific needs. This can lead to behavioural or to mental disorders, or even to non-acceptance or aggressiveness on the part of the patient. For this reason, taking dementia into account is a very important part of the therapeutic approach.
MyH: How often does it happen that dementia will first be detected during a hospital stay?
AS: This happens quite frequently. Generally speaking, it is assumed that about a third of dementia cases are known of and documented. Another third consists of cases in which dementia is suspected, and for another third, it goes unnoticed. Also, when we consider the cases that are admitted in the hospitals, dementia is only known and documented among a minority of patients.
MyH: To which extent are the hospitals prepared to meet such specific requirements?
AS: Generally speaking, we can say that there is still some room for improvement. However, in regard to specialised geriatric institutions, where older, ailing patients are treated and taken care of, the situation may look better. One of the main objectives of the National Dementia Strategy concerns precisely this aspect, wherein patients should be offered a comprehensive treatment program that is flexible and adapted to their needs.
MyH: Would hospitals consider offering a specialised department for patients with dementia?
AS: At the moment, this does not seem to be the case as far as general hospitals are concerned. A dementia station in each department would not be implementable. However, more and more hospitals are able to offer geriatric departments, in which older, multi-morbid patients with dementia can receive treatments.
Specialised departments already offer such services, such as geriatric departments in psychiatric clinics, or, as a model, the psychogeriatric clinic at the Felix-Platter Hospital, a model that is unique in Switzerland.
MyH: How does the Felix-Platter Hospital approach the medical and nursing care of patients with dementia? Do they apply a specific concept?
AS: The university centre for geriatric medicine is the largest geriatric clinic in the German-speaking part of Switzerland. We focus on dementia and provide information regarding dementia to all departments. When in our care, all patients systematically undergo a basic examination in order to find out if dementia can be established. For patients for whom dementia is already far advanced, our psychogeriatric department has 20 beds to provide for those patients.
MyH: People with dementia often react aggressively or confused when finding themselves in challenging situations. How do you train your personnel in this regard?
AS: Generally speaking, the specific training of nursing personnel in regard to dementia is still a very specialised issue. In this field of study, much training is still needed. At the Felix-Platter Hospital, we consider this as a very important issue. Most of our nursing staff has already attended such specialisation classes.
In this regard, issues concerning how to deal with aggressiveness are also addressed. The participants become acquainted with how aggressive behaviours emerge and how to protect oneself when confronted to such a situation, but also how to acquire de-escalation strategies or specific movements to ward off any aggressive behaviour without harming the patient.
Thanks to regular continued education, nursing staff learn how to better cope with the pressure, both on a mental and on practical level. This gives them more assurance and provides them with a confident behaviour. This is very important, for insecurity can sometimes provoke aggressiveness on the part of the patient.
MyH: We have already addressed the role of the close family members…
AS: Indeed, the role of the patient’s family members is very important. Many a procedure can only be performed with their collaboration. They assume charges, they explain, they have a direct and personal contact with the patient. Also of great significance is the psychosocial situation of the family members, for they also need to find solutions as regards what obligations or any wish they may have, but also what is possible for them to do.
Should such a challenge occur, for example when a close relative is not able to assess the situation and his own capacities realistically, or when they find themselves between wishes and promises on the one hand and with reality on the other, this can also become quite problematic.
MyH: Which measures and solutions should be established as priorities for the coming years?
AS: In most hospitals, there needs to be increased sensitization in regard to the high occurrence of patients with dementia, and that these numbers will most likely increase in the coming years. According to the National Dementia Strategy, about 110 000 people are affected with dementia in Switzerland.
These numbers are expected to double by 2030, and triple by 2050. This means that offers need to address this reality. Dementia must be addressed in all health-related fields and specialised fields such as geriatric and psychogeriatric must be integrated into all fields.
MyH: The Felix-Platter Hospital offers since a number of years a certificate in “Dealing with patients with dementia”. Who is this course designed for and what are its main elements?
AS: The course is intended for nursing staff as well as for people working in therapeutic fields and people in the health system administration. It has a broad approach and is very practical. It provides knowledge and ways to implement it in regard to a specific situation. Highly qualified teachers ensure that the right qualifications are passed on in regard to practical measures as well as behavioural and communicational aspects, but also basic knowledge about dementia, ethical aspects, etc.
MyH: Dr Studer, many thanks for your insights on this issue.
Interview: Patrick Gunti – 06/2014
Photos: FPS and pixabay