Getting it right for dementia patients


Bridget Fordham, dementia nurse specialist

Much has been made of the poor care the elderly can sometimes experience at the hands of hospitals in the NHS.

Some of the most depressing cases involve dementia patients - as shown in the dossier of "appalling" cases highlighted by the Patients Association a few weeks ago.

Last week a report by monitoring body Dr Foster gave an insight into the difficulties hospitals are facing with overcrowding which makes providing the right care for the frail and elderly more difficult.

But that doesn't mean there aren't places getting it right - as I found out when I visited the world-renowned Guy's and St Thomas's Trust in the heart of London.

The trust has been giving special consideration to the care it provides to dementia patients for some time.

Part of this involves providing specialist dementia training to staff, which has been happening since 2009.

At first it was given to nurses and other key staff such as speech therapists and dieticians, but it has now been rolled out to the entire workforce from doctors to porters.

'Big difference'

Bridget Fordham, the trust's clinical nurse specialist for dementia, told me: "Our staff said that of all the patients they dealt with they were the most unsure about those with dementia.

"They just did not have the confidence or skills to deal with them. Dementia patients can get very agitated. Delirium is a big problem.

"So we started doing some training to help. Staff say it has made a big difference and helped them in the way they care for patients."

But the trust has also sought to make changes to the physical environment to help dementia patients.

In the three elderly care wards at St Thomas's Hospital doors to toilets and washrooms have been colour-coded with bays to give patients visual prompts in finding their way round.

Bathroom door Doors to bathrooms are colour-coded with bays so dementia patients can find their way round more easily

Padded flooring has also been laid to help soften falls, which are more likely among dementia patients.

A number of other measures have been introduced trust-wide.

These include a print of a forget-me-not which is placed above the bed of all dementia patients to alert staff to their condition. Dementia patients are also given blue wristbands to wear.

This has proved particularly useful if patients have wandered away from their wards, as Ms Fordham explains.

"We obviously don't want to lock patients in and people with dementia can go wandering so what this does is tell staff that this patient has dementia and should not be out on their own.

"We have had security staff finding patients and because they have had the dementia training they understand the situation and know how to approach them."

Red trays and beakers are also used to signify which patients need help with nutrition.

Nurses on the elderly care wards believe the aids have been a big help.

Deputy charge nurse Jim Domingo says: "They are really useful. If you are coming back from some time off or when there is agency staff working it just makes sure we know straight away who needs what."

Patients and their carers appreciate these measures too. Christine Nethercott, 64, from nearby Bermondsey, has been a regular visitor to St Thomas's over the past five weeks as her mother, Eleanor, has been recuperating from an infection.

While she has been in, Eleanor has had dementia diagnosed.

"It's really reassuring to know staff will be aware of my mother's condition and looking our for her when I am not here," says Christine.

"I must say the care she has received has been wonderful."

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 42.

    When will "the powers that be" realize that Care of the Elderly although HARD WORK is a Speciality called Geriatrics just as the opposite end is Paediatrics..Nursing in this area takes patience plenty of patience and money. I worked in it all as a young trained Nurse 1980's for 11 years Psychiatric/Senile Dementia as was known then Rehab & Terminal.
    G Hospitals were all closed thanks to Mrs T.

  • Comment number 41.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 40.

    About time. My late Mother was unfortunate to enter the system just after the coallition came in. The Hospital Consultant, the Local Authority social services and county council were only interested in money/costs/budgets. I was explicitly told repeatedly there is a fixed limit to what we can spend on your mother, that has to come first. Yet the Goivernment turn their face away and spin figures.

  • rate this

    Comment number 39.

    If you want a half decent NHS, don't vote Tory - simple as that. Despite their shortcomings, Labour (not a big fan - far too right wing) did a fantastic job of cutting down ridiculous waiting times for ops etc. You can't put a price on having a good NHS - the money is there, but we just waste it on wars, the Olympics etc.

    Don't vote Tory and then moan when Granny is receiving poor care!!

  • rate this

    Comment number 38.

    i worked in a private nursing home which catered for 52 eldearly residents with dementia,stroke victims,amputees all incontinent of urine and feaces the overwhelming majority could not walk,needed help with feeding etc. on nightshift there was one nurse and four carers to look after the residents. an average of one carer to nine or ten residents. this ratio applies to most nursing homes.

  • rate this

    Comment number 37.

    Why do so many people moan about constructive action. Nobody is claiming the points addressed solve everything, but they are positive - so just lighten-up people! From personal experience (as a patient) I can testify that St. Thomas' is an excellent hospital with a fine staff. We are fortunate to have such a great NHS hospital in central London.

  • rate this

    Comment number 36.

    In spite of bad press re care of dementia patients, no mention has been made of concerns raised a year ago by over 50 health and social care organisations calling for fresh action to cut prescriptions of "chemical cosh" drugs.
    Maybe this still is the easy way for some care homes to deal with difficult patients using powerful drugs as they were on my late wife 6 years ago, without my consent.

  • rate this

    Comment number 35.

    Jimmy00008: Maybe I can help. I'm a nurse with dementia patients. In Staffordshire the Older Adults Community Mental Health Team was closed, non demented patients added to working age adults CMHT's caseload and dementia services withdrawn for all but those with 'challenging behaviour.' Relatives, who provide by far the most of the care, now have no support except what is offered by charities.

  • rate this

    Comment number 34.

    Fully agree with no. 17, this is old news, a shame it's taken the NHS so long to catch up. But costs still need to be addressed, it's the number of staff and their training that really matters.

  • rate this

    Comment number 33.

    28. When you say 'carers', are you referring to nursing and support staff in hospital?

    31. My mum has been in one of the elderly care wards at St Thomas' since they implemented these changes, and as her carer, I'm reassured that all of the staff involved in getting her better knew to factor in her dementia. On the balance of risks, I'd rather staff knew about her dementia

  • rate this

    Comment number 32.

    @WANAITT #28 Could give your source for this sweeping statement, please? As a nurse caring for people with dementia I would like to explore the literature you have read on this subject. Thank you

  • rate this

    Comment number 31.

    Blue namebands and pictures over the beds of dementia patients for all to see... what happened to patient confidentiality?

  • rate this

    Comment number 30.

    1 Hour ago

    "Can someone with influence have a word with the PM and get him to roll it out. He won't listen to the electorate."

    Oh yes he does that's why he has put his top PR man in charge of the NHS. His agenda is quite simple: if he tells it like you want to hear it - its' sorted! The sycophantic Press nod to his every whim, so nothing will change. More privatisation on the way

  • rate this

    Comment number 29.

    As a healthcare planning company that carries out work for the NHS we have implemented some of these features in 3 recently completed ward refurbishments, namely signage and demarcation of patient areas from non patient areas.
    These can be used for all wards as is not something that screams out dementia only.
    Provides flexibility and as stated it does not cost much if included at the design stage

  • rate this

    Comment number 28.

    Sadly there is a lack of understanding or desire on the part of the Carers to empathise with sufferers, and this does lead to further problems like falls & accidents, which exacerbate their problems, but quite often some Carers use this condition as a get out clause for their own neglect, and omissions as they know patients are rarely relied on to give accurate facts.

  • rate this

    Comment number 27.

    20.aggie - ".....That is fine until medical/surgical intervention is needed, while medical notes inform staff that the patient has mild dementia this does not seem to be taken on board...."

    I know - because there's not enough cash to hire enough nurses to enable them to have smaller rotas of patients to care, to enable them to get their heads fully round each patient's individual needs.

  • rate this

    Comment number 26.

    It's nice to see a really positive story for a change.
    Simple ideas/concepts which will really help & won't cost much - it's certainly cheaper than buying yet another nuclear submarine or arming terrorists/freedom fighters (delete according to viewpoint) in Syria etc

    Can someone with influence have a word with the PM and get him to roll it out nationwide? He won't listen to the electorate.

  • rate this

    Comment number 25.

    It is rare that the private sector come up with good treatment ideas, after all thinking things through and carrying out training takes time, and time is money. And money belongs with the shareholders, or at least the banks that lend them the money to buy the shares. Then they patent it, rather than share it.

    Sadly, I get more and more cynical as the years go past. Experience, may be?

  • rate this

    Comment number 24.

    Most of these steps are common sense if you think about it but it has taken someone to actually think about it and the will power of the hospital management to implement it, even though most don't cost much money.

  • rate this

    Comment number 23.

    good to see things are improving for dementia patients. its all very well saying that they shouldnt be in hospital, when my grandpa was taken in after a fall, the nurses took weeks to cope with just his medication before he was allowed to be released to a specialist carehome (after being cared for solely by my gran). anything to make a transition like that less traumatic for the patient is a plus


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