Dáil debates

Thursday, 14 May 2015

Implementation of National Dementia Strategy: Statements (Resumed)


1:20 pm

Photo of Tom FlemingTom Fleming (Kerry South, Independent) | Oireachtas source

Alzheimer's disease is the most common form of dementia, accounting for 60% to 80% of cases. Its onset is most common in individuals aged 65 years and older, although people in their 40s and 50s can also develop early onset Alzheimer's disease. Although it is one of the leading causes of death, there is, unfortunately, no way to prevent it, cure it or slow its progression. Extensive research carried out in recent years, particularly in the USA, has produced some promising medical advances and drug trials, but we have not yet seen a successful breakthrough formula.

Approximately 36 million people live with dementia worldwide. In Ireland an estimated 50,000 people are likely to have dementia. It is likely that the incidence of dementia will increase significantly in the future given our ageing population. We need to plan services in a strategic and coherent manner and in so doing we can learn from countries that have well developed policies and national strategies. The national dementia strategy is a major step forward in the delivery of services and supports and emphasises that most dementia patients can continue to live well and participate in their communities. I commend the Minister of State, Deputy Kathleen Lynch, for her contribution to the development of the strategy. I acknowledge her commitment and that of the Minister for Health to rolling out the strategy at the earliest opportunity.

The Department of Health, the HSE and Atlantic Philanthropies have pledged funding for an investment programme of intensive home supports, home care packages and dementia specific resources for GPs who are crucial as a first point of contact. I also welcome the measures aimed at raising public awareness, addressing stigma and promoting inclusion and involvement in society. It is important that we implement all elements of the strategy in an urgent timeframe. In the light of the gradual improvement in the economy and Exchequer returns, it is imperative that we prioritise the roll-out of the strategy, with delivery of the action plan for GPs to access specialist services. Early detection and diagnosis are crucial for patients. Staff training and development programmes for carers and emergency department staff are important in this regard.

It is estimated that approximately 26,000 dementia patients are living at home with the help of family carers. Evaluations suggest the number of family care givers to dementia patients is as high as 50,000. These care givers are central to the community care system but few of them receive financial compensation from the State by way of a carer's allowance or social welfare benefits. It is not easy work, but it is a labour of love for the individuals concerned. They need more recognition, support and relief for this intensive work. Families also want to be more closely involved in the process of caring, including making decisions about the services needed to help them in their care giving roles. In the absence of the required level of community care supports, a key element of the strategy will be a more formal partnership between family care givers and the institutional system of care. Families face a heavy burden in providing care around the clock and preventing their relatives from being placed in long-term care institutions prematurely. Patients are more comfortable within the home environment where this is possible. We should strive to ensure this will continue for as long as possible, with support from community and health services.

Evidence from other countries suggests a significant proportion, up to 25%, of older people admitted to hospitals have dementia, but we lack reliable data for the prevalence of dementia in Irish hospitals. As dementia is often hidden in the community, it may remain undetected following admission to hospital. Even when older people are admitted through accident and emergency departments, dementia is often overlooked in assessments. This a cause of concern because the reasons given for admitting patients with dementia are often other age related complaints rather than the patient's social circumstances such as a breakdown of care giving arrangements. The hospital experience can be frightening and disturbing for an individual with dementia who needs a consistent and stable environment that reinforces self-identity and personhood. The hospital setting, with its multiple and competing stimuli, is far from ideal for patients suffering from severe cognitive impairment. General hospital staff do not always have the necessary skills and expertise to provide dementia care. One Irish study revealed that only 5% of junior hospital staff had received dementia care training in recent years. Caring for patients suffering from dementia who exhibit challenging behaviour such as aggression, paranoia, hallucinations or sleep disturbance can be particularly difficult for hospital staff.

Once admitted to hospital, people with dementia often have worse outcomes than older people without that affliction. Evidence suggests the length of stay of dementia patients in hospitals is longer and costlier and that patients are more likely to be discharged to a residential care setting. These patients are also known to have a higher rate of other illnesses and higher mortality rates and they often acquire new dependencies as a result of being inactive for prolonged periods.

In other countries, including Scotland, the United States and Australia, innovative approaches have been adopted towards the care and treatment of people with dementia in hospitals. These include the development of dementia champion programmes, which include the appointment of specialist staff within the hospital with a dementia remit. These are qualified staff who take ownership of patients with dementia in hospitals and who help raise awareness of dementia and encourage a more person-centred approach to care. Other approaches used internationally include outreach and community based specialist dementia services which reduce the risk of hospital admission for people. There are many reasons hospital staff should be aware of whether patients have dementia, not least the fact that patients admitted with dementia are at an increased risk of developing delirium. A dementia champion programme in general hospitals would facilitate more awareness of dementia care in such a challenging environment.

There is a need to develop better hospital patient information systems that will yield data that will more accurately reflect admissions, readmissions, length of stay and discharge of people with dementia from hospitals. We need a major review of the care of patients with dementia in general hospitals in Ireland. We also need more awareness of the signs of dementia, which are often not very visible. Specific training should be provided for staff in that regard. Staff should be upskilled in the recognition of symptoms and in the communication of this information to other staff so as to improve the provision of dementia friendly care in the hospital setting.


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