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Care for dementia in hospitals 'a disaster' says consultant


A leading consultant in geriatric medicine has called for special training for hospital staff working with dementia patients.

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.’


Readers' comments (3)

  • It isn't understandable why Professor Cucinotta states that general nurses are insufficiently trained when those who work within the adult general wards do have some training in working with dementia, especially those in care of the elderly who have access to modules in dealing with cases of dementia. They also have training in handling violent and aggressive patients and do not advocate using restraints on them, it is illegal in general medical nursing.

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  • I agree with anonymous above (03/04/2009). Restraint of any patient is illegal in general nursing in this country, and I sincerely hope that it does not occur. General nurses do have some training in violence and aggression, though the complexity of managing patients with dementia on a general medical ward is not covered in this training. Nurses have to have the patients best interests in mind when considering any treatment. More training on managing dementia sufferers is needed. Also swifter response times from referrals to psycho-geriatricians.

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  • Most of what Professor Cucicutta said if not all is advice is possible to implement.Easier said than done.
    Staffing levels and the quality of staff on the wards needs to be put in question.
    No doubt the Nurse in Great Britain are well trained and I 'll'd disagree thah patients in the United Kingdom get restrained.
    What needs to be improved is the skills of Health Care Assistants.Most of at risk client especially of falls and self harm are placed on 1:1 care monitored by level 1 Nurses and sometimes Carers.

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