Care for dementia in hospitals 'a disaster' says consultant

Speaking at the British Geriatrics Society convention in Bournemouth yesterday, Professor Domenico Cucinotta, of the Department of Geriatric Medicine in Villa Laura Hospital, Italy, claimed that general hospital staff are insufficiently trained to deal with the complexities of the disease, particularly when it comes to comorbidity.

‘Sometimes care of dementia patients is a disaster. Why? They come with an additional disease or disorder with complicates dementia’, Professor Cucinotta says. ‘So they experience delirium, some are disabled or dependent and the decisions made in their care can be problematic if you don’t have sufficient know how.”

Professor Cucinotta, whose previous work includes past research into senile anorexia, Analysis of HFE gene mutations and Multicenter clinical placebo-controlled study with acetyl-l-carnitine (LAC) in the treatment of mildly demented elderly patients, has identified four key areas for improvement within acute hospital wards; behaviour management, pain relief, support for carers and management/co-ordination of care. He also claims that staff have a tendency to restrain patients rather than examining the cause of their distress.

 ‘Restraints should be used only after a complete assessment - all other types of intervention must be examined before the use of restraint by nurses.

‘Staff should be trained to anticipate challenging behaviour and to manage violence, aggression and unexpected behaviour and health care plans should be based on the inpatient physical and mental health needs rather than general best result drugs should being used for individuals.’

While this may lead to high levels of anxiety among staff, Professor Cucinotta maintains that the patients themselves often suffer unnecessarily.

‘Pain is often undetected [by nurses]. There are non-obvious signs of suffering that do not get picked up on’, he explains. ‘In severe dementia cases, treat the pain, not the dementia. Do not assume that they do not feel pain because this is wrong.’

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