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 62.

    I hope I'm not being offensive but I would prefer to die with dignity rather than be a burden on my family, the NHS and suffer a poor quality of life and perhaps not even recognise my children.
    Surveys show that the majority of people think the same.
    Given the increasing numbers of old people, of which I am one, and the pressures on the public finances, matters can only get worse.

  • rate this

    Comment number 61.

    Well lets look at the facts, its lack of care, lack of compassion, loss of dignity, welcome to care in the uk!

  • Comment number 60.

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

  • rate this

    Comment number 59.

    52.A Hugh-Man - ".........................and less overall distress.
    Of couse properly staffing would help too."

    The only problem is NOT enough staff, it would not help "too" it would help enormously full stop.....

  • rate this

    Comment number 58.

    I don't want to cause further distress to anyone but the title of this article is "Getting it right for dementia patients".

    I posted earlier of the unnecessary overuse of powerful drugs after reading article June 2011 disclosing that almost a quarter of patients were being "chemically coshed" leaving me wondering if/how much it is still going on?

  • rate this

    Comment number 57.

    @Josy HCA's do receive alot of statutory training but have no official qualification or governing body. This is because they work under the Registered Nurse, who is accountable for their practice. Nurses are accountable to both the NHS and NMC=PRESSURE

    Finally, staff levels are based when wards run at 80% capacity, however most wards run at 100% capacity meaning they're constantly understaffed.

  • rate this

    Comment number 56.

    All the more reason for us to as Trained Nursing Staff to advocate for these people.. Today there seems to be a real lack of understanding for vulnerable people and they are treated without dignity.. we have regressed all in the name of Money!

  • rate this

    Comment number 55.

    The obligatory wait in most A&E is around 4 hours, whereas you maybe seen in an urgent care centre after less of a wait.

    Health care assistants do not have any statutory training, yet are allowed to care for your loved one; because you have no option, you put up with it. NHS, although providing care to all & sundry, is unable to cope with the demands made on it.

  • rate this

    Comment number 54.

    While dementia is currently in the news, the media will cover the topic, another more scarey topic will be along sometime soon, for us to get on that bandwagon.

    What people have to understand is that they have the choice of whether to care for their relatives in their own home, (which is preferred by many) or turn up with an ill, and demented patient at A&E?TBC

  • rate this

    Comment number 53.

    My elderly Mom is in Bhams QE. She has multiple problems but also has Vascular Dementia. The lack of understanding & basic nursing care is scarey. Mom has her second bout of tummy bug since being in hospital & is losing weight rapidly.She isn't eating or drinking very much unless I'm there & has been left in a soiled bed several times.No dignity, no basic care even her TV headphones being taken!!

  • rate this

    Comment number 52.

    I have one word "Dignity" Where is it ?
    Often lost for dementia patients and under these precautions they it is less likely to be lost more. Less failure to get to the bathroom in time because they can't remember where is it, fewer confused arguments with staff over who they are and where they are meant to be and less overall distress.
    Of couse properly staffing would help too.

  • rate this

    Comment number 51.

    Remind me again - how many nurses have had to be sacked since the Coalition came in to hit their "efficiency" targets...???

    Both the Tories & the Neo Lib "Mini Me" Tories (they prefer the spin style name of Orange Book "Liberals") just assume that efficiency gains can be made in order to make the numbers fit their preconceived ideas of reducing spending.....

  • rate this

    Comment number 50.

    I have one word "Dignity" Where is it ?

  • rate this

    Comment number 49.

    I saw the toll this terrible condition took on my grandmother Irene, a strong but loving woman reduced in her old age to brief moments of lucidity and childish sorrow. It was pitiable. This cannot be ignored we need research into cures, treatments and money for better care. Life sciences should be at the heart of our research efforts for the next 50 years until we defeat it.

  • rate this

    Comment number 48.

    As a psychiatric nurse let me tell you we are run off our feet! Forget high profile St Thomas's Nick do your home work and visit a real acute dementia ward, not enough staff, time or resources but real people who care unlike this government who are hoodwinking the public and not telling them the truth in order to gain votes!

  • rate this

    Comment number 47.

    I used to care for mother in law who had dementia. She broke her hip and spent an agonising 7 weeks in hospital. I spent my waking hours at her bedside looking after her. The nurses didn't have time for her and the hospital didn't have a special ward. It was horrendous for her, me and the other patients. This was 6 years ago we so need our hospitals upgraded to cope with dementia patients.

  • rate this

    Comment number 46.

    My mum is only 59 and she's on a severe dementia ward of a nursing home. She often appears very dry mouthed there though and often complains of thirst. I got a doctor in hospital to test her for dementia after she had a fall six months ago and he diagnosed her with moderate dementia, I had raised concerns with her GP repeatedly for a few years before but was ignored. GP's are an obstacle to care.

  • rate this

    Comment number 45.

    NHS staffing issues which contribute to poor care are also exacerbated by the over prioritisation of form a doctor i fill in forms to assess VTE, diabetic foot, dementia to name a few for every patient. Its even worse for the nurses. Rarely do these correlate with good care but they are financially rewarded (or rather trusts are fined when they are not done!)

  • rate this

    Comment number 44.

    Lack of nursing staff and moving patients several times an admission both contribute to a frightening hospital experience. Yes, care homes manage with lower staff to patient ratios, but they are less likely to be dealing with an emergency in the next bay. Such situations in understaffed wards leave shouts of "nurse" unanswered whilst immediately life threatening issues are dealt with.

  • rate this

    Comment number 43.

    Hmmm? They really should bring back hanging. There are just to many seagulls in this town now! What day is it? I'd love a cuppa!
    Now that's an exert of my ma in general conversation and she has always been like that. Jumps from one subject to another in a wink of an eye! She is now in her 90's!


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