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A&E nurses to screen for dementia

A Midlands hospital has created two nursing posts to screen older emergency patients for dementia.

The Chesterfield Royal Hospital has appointed two dementia assessment nurses whose role is to assess every emergency admission over the age of 75 to see if they have signs of dementia.

The assessment is made using the FAIR system – Find, Assess, Investigate and Refer.

It is intended to help eliminate an incorrect referral, for example, the patient could be delirious or be suffering from an infection that can produce confusion and disorientation that can mirror characteristics of a dementia.

If the assessment triggers an undiagnosed case then a referral is made to the most appropriate service such as older peoples’ mental health team, GP or a geriatrician with an interest in dementia.

One of the nurses Melody Spencer said: “Research has shown that four in 10 patients have an undiagnosed dementia so our role ensures these patients don’t slip through the system and provides them timely access to a specialist assessment.”

Her colleague Marcia Young said: “We assess whether or not somebody has been more forgetful over the past 12 months, by asking to what extent it has significantly affected their daily life.

“It is normal for people to enter a room and for a split second not recall why they went in there however, with a dementia, people can lose the ability to function effectively, for example, they may go into the kitchen to make a cup of tea and not be able to remember how to carry out the task.”

She added: “We currently see all patients admitted within the previous 24 hours on a one to one basis and carry out the Find part of the FAIR assessment. This identifies anyone who is requiring further assessment and investigation.

“We then make the request for the patient’s team of doctors to carry this out. We continue to follow up the patient and ensure that this is completed before they are discharged thus ensuring an appropriate referral is made if required.”

Readers' comments (12)

  • This became less interesting when I realised it did not read 'A&E to screen nurses for dementia'.

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  • I did that too!

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  • why do nurses need to screen for dementia? It is true that shift working leads to disorientation but this is usually transitory and dementia is presumably relatively rare among a younger workforce.
    Forgetfulness can also be produced by stress, multitasking and fatigue, especially in older workers.

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  • michael stone

    Anonymous | 7-Dec-2012 8:43 am

    This is very worrying - shiftworking, stress, multitasking and fatigue seem to apply to nurses, so are a lot of nurses making the same type of 'mistakes' that dementia patients make ?

    I also originally read this one as 'A&E to screen nurses for dementia', by the way !

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  • I am 67 years old. I am fit and have no health related issues. Sadly, I recently injured my shoulder when I was knocked off my motorbike.

    Shortly after arriving in A&E I was subject to a "nurse" "assessment" of my "mental" state and ability to undertake normal activities of daily living!

    I was. at the time, in pain and failed to appreciate the humour of the situation. I therefore asked her the name of the
    Minister of Health. When she could not reply I told her she was clearly suffering an early onset of dementia and requested she go away! She went!












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  • Anonymous | 8-Dec-2012 7:49 am

    a very amusing story. when we did the ward round and a doctor did a quick check to check the orientation of a patient we couldn't always answer the questions. Especially one relating to events donkeys' years ago or what day or date it was as on shift work full time this can easily be momentarily forgotten. one gets into a routine of getting up and going to work no matter whether it is a weekday or weekend and in the office writing up notes later on we would often ask each other what the day or date was!

    Common sense as applied to each individual situation and patient seems to have gone way out the window in the name of following guidelines, protocols, box ticking and organisational political correctness and such systematic routine tests of the cognitive abilities of the elderly could become highly stereotypical, subjective, judgemental and discriminatory.

    I would suggest that nurses and other medical workers make sure that their own cognitive apparatus is switched on and properly engaged in gear before attempting to apply it to others.

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  • just imagine it. over 60 tested for dementia. the findings will go into your notes and onto a data base and you will be labelled as having a mental health problem and penalised for things such as insurance, jury service, etc. which could affect things like driving, life time holidays you were unable to take during you working life and raising a family, financial services, etc.

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  • Anonymous | 8-Dec-2012 8:11 pm

    ....and don't forget, meeting targets, whatever it takes. Being over 60 myself, all this screening of this and that leaves you feeling there must be something wrong with you, instead of letting us get on and enjoy life

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  • Anonymous | 12-Dec-2012 11:57 pm

    from Anonymous | 8-Dec-2012 8:11 pm

    I agree with you wholeheartedly.

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  • from above, furthermore if you live in a country where there is insurance, doctors will to carry out extra diagnostic tests and treatments which may not be needed in order to get extra pay to support their costly practices, the maintenance of their equipment and possibly to fill their own pockets. In one European country there is currently a debate going on about the obligatory and harmful x-rays dentists consider an essential part of their annual dental check on patients! My dentist in the UK uses X-rays as a guide only if there is a problem not as a superfluous routine examination.

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  • if I have to present to A&E I will answer any questions relating to the condition which brought me there but no others because of the poor data protection in the UK and discrimination. This will probably lead to a note of non-compliance but better than any subjective judgements of dementia.

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  • contd from above

    there must be no obligation of coercion to reveal any personal information other than that required to diagnose and treat current or related conditions.

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